Squamous cell carcinoma of the skin natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]
Overview
Squamous cell carcinoma of the skin can develop on any cutaneous surface; however, it is most common in sites frequently exposed to the sun including: head and neck, dorsum of the hands and forearms, upper and lower limbs, back, and chest. It is not very common for cutaneous squamous cell carcinoma to arise in non-sun-exposed skin; however, in dark-skinned individuals the symptoms of squamous cell carcinoma of the skin typically develop in non-sun-exposed skin.
Natural History
- Squamous cell carcinoma of the skin can develop on any cutaneous surface.
- In fair-skinned individuals the symptoms of squamous cell carcinoma of the skin typically develop in sites frequently exposed to the sun.[1]
- Head and neck - 55 %
- Dorsum of the hands and forearms - 18 %
- Legs - 13 %
- Arms - 3 %
- Shoulder or back - 4 %
- Chest or abdomen - 4 %
- It is not very common for cutaneous squamous cell carcinoma to arise in non-sun-exposed skin; however, in dark-skinned individuals the symptoms of squamous cell carcinoma of the skin typically develop in non-sun-exposed skin.[2]
- Sites usually affected in dark-skinned individuals include the legs, anus, and sites of chronic inflammation.
Complications
- Common complications of squamous cell carcinoma of the skin include:
- Spread to lymph nodes
- Metastases into other tissues and organs especially the lungs and bones
- Death
Prognosis
This lesion has a cure rate of 95% - 98%. But once the lesion spreads to other regions beyond skin, like lymph nodes and internal organs less than half of the patients live five years. A sub set of SCC carries the risk of local recurrence, nodal or distant metastasis (usually to the lungs) and eventually death. Tumors in this sub set are termed high risk SCC. Tumor related factors in high risk SCC are
- Tumor size greater than 2 cm (1.5 cm for lesions on ear or lip) - Lesions less than 2 cm have a metastatic potential of 9.1% whereas in those of size more than 2 cm the rates spike up to 30.3%.
- Invasion to subcutaneous fat : less than 2 mm - 95% survival rate, from 2-9 mm - 80% survival rate, more than 9 mm - 65% survival rate.
- Poorly differentiated cells
- Recurrent tumor
- Perineural involvement - the metastatic rate in such involvement can reach 45%. The degree of nerve involvement likely has a major impact on the prognosis. [3]
References
- ↑ English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998). "Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study". Int J Cancer. 76 (5): 628–34. PMID 9610717.
- ↑ Mora RG, Perniciaro C (1981). "Cancer of the skin in blacks. I. A review of 163 black patients with cutaneous squamous cell carcinoma". J Am Acad Dermatol. 5 (5): 535–43. PMID 7298919.
- ↑ 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 lip. Implications for treatment modality selection. J Am Acad Dermatol. Jun 1992;26(6):976-90