Squamous cell carcinoma of the skin differential diagnosis

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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 should be differentiated from melanoma and basal cell carcinoma. It accounts for 20% of all non-melanomatous tumors, and is fairly invasive contrary to its counterpart, basal cell carcinoma. Squamous cell carcinoma typically presents as a non-healing ulcer or growth on a sun exposed area of the skin.

Differentiating Squamous cell carcinoma from other Diseases

A few conditions that mimic Squamous cell carcinoma include the following;

• Actinic keratosis (also called solar keratosis, or AK) is a premalignant condition consisting of one or multiple thick, scaly, or crusty patches on the skin. It is most common in fair-skinned people who are frequently exposed to the sun, due to lack of the protective pigment called melatonin. Actinic keratosis are pre-malignant lesions caused by solar damage that can progress to squamous cell carcinoma, and should therefore be treated.It usually is accompanied by solar damage.
• Atopic dermatitis (Atopic Eczema) is a hereditary, non-contagious skin disease characterized by chronic inflammation of the skin.
• Atypical fibroxanthoma is a tumor that occurs primarily in older individuals when the skin of their head and neck area is exposed to sun and/or therapeutic radiation. Clinically, lesions usually are suggestive of malignancy because they arise rapidly in skin where other cancerous lesions have been found and treated. Clinical presentation is a red, beefy, sessile nodule. Solar telangiectasias can be found around the lesions.
• Bowenoid papulosis presents as papules on the genitalia of both sexes and is induced by infection with HPV. Many of these lesions are benign, but there are case reports of malignant transformation (2.6%).
• Contact dermatitis
• Erythroplasia of Queyrat is squamous cell carcinoma in situ of the penis.
• Keratoacanthoma is a low-grade malignancy of the skin. It originates in the pilo-sebaceous glands, and is similar in its clinical presentation and microscopic analysis to squamous cell carcinoma, except that it contains a central keratin plug. Statistically, it is less likely to become invasive than squamous cell carcinoma.
• Bowen's disease is a sunlight-induced skin disease, and is considered to be an early form of squamous cell carcinoma.
• Marjolin's ulcer is a type of squamous cell carcinoma that arises from a non-healing ulcer or burn wound.
• Melanoma
• Basal cell carcinoma is the most common skin tumor accounting for 80% of all non-melanomatous tumors of skin. It is a malignant epithelial cell tumor that begins as a papule (a small, circumscribed, solid elevation of the skin) and enlarges peripherally, developing into a crater that erodes, crusts, and bleeds
• Pyoderma gangrenosum is an uncommon ulcerative condition associated with systemic disease in at least 50% of cases. This condition is a diagnosis of exclusion.