Squamous cell carcinoma 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]

Natural History

Once Squamous cell carcinoma (SCC) develops on the skin it grows slowly. If neglected and once it reaches the size of 2 cm and more it is three times more likely to spread to other areas than the smaller lesions. Usual size ranges from 1 cm to 5 cm. It is the mechanical interference of this fungiform exophytic lesion that brings it to the notice of the patient or the clinician.

Complications

When treated, early squamous cell carcinoma is completely curable by 95% - 98%. If left untreated it has the tendency to spread to other areas like lymph nodes, internal organs. Immunosuppressed patients have a far more tendency to develop aggressive form of the tumor. Other possible complications of this tumor are skin abscesses and Cellulitis. The primary complication of this lesion once treated is recurrence, which usually occurs with in the first year after resection.

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 location (ie. lips, ears, anogenital region, within a scar or chronic wound) - Metastatic rates for lesions on lips (13.7%) and ears (11.%) are particularly high. The 5 year survival rates after metastasis from these sites are usually range from 25% - 40%. Primary SCCs on the trunk and limbs are associated with a metastatic rate of 4.9%. Marjolin's ulcer, a sub type of SCC behaves aggressively with a metastatic rate of 35%. Similarly SCCs arising from injured and chronically diseased skin have a metastatic rate of 40%.
• 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.

The 3 year disease specific survival rate for SCC is 85%. The figure reaches 100% in lesions with no high risk factors. The overall survival rates drop down drastically once the lesion spreads to lymph nodes and internal organs.

References

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