Squamous Cell Carcinoma of the Skin (SSC)

  • SCC is a non-melanoma skin cancer:
    • That arises from keratinocytes of the epidermis
    • It accounts for one fifth of all skin cancers:
      • Is more lethal than basal cell carcinoma:
        • As difficult-to-treat metastatic disease:
          • Can occur in up to 5% of patients
  • Management of SCC, like basal cell carcinoma:
    • Consists of adequate local control:
      • Several characteristics have been identified to stratify lesions at high risk for recurrence:
        • These include:
          • Tumor size greater than 2 cm
          • Ulcerated
          • Location on the:
            • Lips / nose / forehead / chin and neck (H areas of the face)
          • Ill-defined borders
          • Previous radiation
          • Chronic scar
          • Immunosuppression
          • Recurrent tumors
          • Poor differentiation
          • Deep Clark level invasion
    • Presence of risk factors directs local therapy:
      • As lesions with no risk factors can be safely excised with 4 mm to 6 mm margins
    • With one or more risk factors:
      • Larger margins should be obtained, and 1-cm margins are recommended, if possible (given local tissue constraints)
    • The use of SLN biopsy for high-risk SCC has been reported in several small, single institutional reports:
      • However, its impact on patient outcomes has not been well defined
  • A highly successful alternative to standard surgical excision is Mohs micrographic surgery, performed by experienced dermatopathologists:
    • This involves serial resections of the tumor with real-time mapping and complete peripheral and deep pathologic evaluation to direct immediate further resection:
      • It has the lowest recurrence rates when compared to curettage / electrodessication, standard surgical excision, and radio therapy
  • Surgical excision with grossly negative margins, with immediate primary closure is inappropriate:
    • As the tumor’s size alone is a negative risk factor precluding smaller (4- to 6-mm) margins
  • References:
    • Brodland DG, Zitelli JA. Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol. 1992; 27:241-248.
    • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Basal cell and squamous cell cancers. Available at: http://www.nccn.org.
    • Renzi C, Caggiati A, Mannooranparampil TJ, et al. Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature. Eur J Surg Oncol. 2007;33:364-369.
    • Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lips: implications for treatment modality selection.J Am Acad Dermatol.1992;26:976-990.

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