Squamous cell carcinoma clinical features

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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

Most squamous cell carcinomas arise on the sun-damaged skin of the head and neck, with fewer lesions arising on the extremities and occasional tumors occurring on the trunk. Early lesions frequently present as a red, scaly spots. Later lesions may form nodules or firm plaques, either of which can ulcerate ( http://tray.dermatology.uiowa.edu). Diagnosis is established by biopsy and histopathological confirmation. Complete excision is curative in the vast majority of cases. Occasionally squamous cell carcinoma will invade along the perineural layer of peripheral nerves and will extend well beyond the clinically apparent mass. Local recurrence is more common in these instances and when present on the head, direct intracranial extension may occur. Metastases to draining lymph nodes occurs in a minority of cases and disseminated disease is the cause of most squamous cell carcinoma-related deaths. Higher rates of metastasis (~15%) are observed with primary lesions of the lips or ears (Rowe et al., 1992). Radiation therapy is helpful in some cases of locally recurrent disease in which complete resection is difficult to achieve and in cases of limited metastatic disease.

History / Presenting complaints

It is easy to find it as it appears mostly in the noticeable regions of the body like face, ears, neck, arms, etc. It grows slowly and presentation depends on the part of the body that is involved. It may vary from simple growing lump , plaque or a bleeding ulcer.

Systemic symptoms of this carcinoma are seen in the advanced stages where the cancer disseminates causing easy fatigability. But few symptoms like dysphagia, odynophagia are seen when tongue, lips or esophagus are involved.

Skin

Persons who present with Squamous cell carcinoma of skin may have one of the following risk factors like

• significant sun exposure
• benign lesions like Chalazion
• chronic ulcers.

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  Squamous cell skin cancer.
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  Squamous cell carcinoma in oral cavity.
  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
• 
  This patient had two adjacent cancers. The flat black lesion below the antitragus is a malignant melanoma. The white elevated keratotic lesion is a squamous cell carcinoma .

Presentation : They usually notice plaque. Ulcers are commonly seen over the face causing disfiguration. At times they can be exophytic over the lips etc.

Tongue and Esophagus

Persons who present with Squamous cell carcinoma of tongue and esophagus are most likely to have following risk factor

• Tobacco chewing/smoking
• Alcohol Abuse
• Poor dental hygiene

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  Squamous cell carcinoma in oral cavity.
  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
• 
  A large squamous cell carcinoma of the tongue

Presentation : Its usually ulcerated in the lateral part of the tongue, pink - red color. Patient finds tough to eat or swallow. As it bleeds on touch or biting. They have dysphagia/ odynophagia when esophagus is involved. In later stages even liquids are tough to go thru. Swelling of lymph nodes is seen in advanced stages where we can find lumps in the neck

Nasopharynx

Persons who have SCC of this region seldom have any risk factors. It most of the times caused by EBV infection.

Presentation : Patient presents with symptoms from the mass effect of the tumour. They include nasal discharge, bleeding, obstruction; ear infection, deafness , tinnitus are complained. Other important complaints include headache and neck swelling due to lymph nodal spread.

Lungs

Persons who have SCC of lungs usually have risk factors like

• Therapeutic radiation (PUVA for psoriais)
• Tobacco smoking

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  Biopsy of a highly differentiated squamous cell carcinoma of the mouth.Haematoxylin & eosin stain.
• 
  Photograph of a squamous cell carcinoma. Tumour is on the left, obstructing the bronchus (lung). Beyond the tumour the bronchus is inflammed and contains mucus

Presentation : Persons who present with SCC of lungs doesn't present usually with any typical symptoms of pulmonary. But in few we may see persistent cough, hemoptysis when it is exophytic and occupies whole of the bronchi which can even lead to recurrent infections.

Penis

Persons who present with Squamous cell carcinoma of penis are most likely to have

• Pre-malignanat lesions (Bowen's disease, Condyloma , Warts)
• Smoking and tobacco chewing

Presentation : Unhealed lesions, subtle indurations may be the intial presentation. Often presentation to the clinic is delayed due to embarrassment most of the times. Warts can be a pre-disposing factor.Large warts lead to infections and necrosis leading to hemorrhages at times.

others

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  Squamous Cell Cancer of the Mouth: Cancer that began along the lower gum line has spread to left submandibular lymph nodes.
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  Squamous Cell Cancer of the Mouth: Cancer that began along the lower gum line has spread to left submandibular lymph nodes.

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  Recurrent squamous cell carcinoma of the auricle (far left) excised with a stellate incision across the antihelix.
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  The final result of the excision.

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  Prostate: Squamous cell carcinoma
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  Prostate: Squamous cell carcinoma

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  Squamous Cell Cancer of the Mouth: Irregular, necrotic appearing tissue on the inside of the mouth due to extensive squamous cell cancer. Patient has limited ability to open his mouth (aka trismus) as a result of the infiltrating cancer.
• 
  Squamous Cell Cancer, Base of Tongue: Note white area with swelling, right base of tongue.
• 
  Squamous cell carcinoma in oral cavity.
  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Cervix: Squamous cell carcinoma

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