Squamous cell carcinoma of the skin is the second most common form of skin cancer diagnosed worldwide. It may resemble a harmless birthmark or scab in appearance and is slow growing. For this reason, it may be underestimated and diagnosed too late by many people. What are the risk factors for skin squamous cell carcinoma? How is it diagnosed and treated?

Cutaneous squamous cell carcinoma (cSCC) is a malignant neoplasm originating from squamous epithelial cells and is classified as a non-pigmented skin neoplasm. It accounts for 15-20% of all skin cancers and is the second most common form of skin cancer after basal cell carcinoma. The term "cutaneous" distinguishes it from other squamous cell carcinomas that can arise in the soft tissues of, for example, the oral mucosa. Recently, there has been an increase in the number of cases of squamous cell carcinoma of the skin.

Skin Squamous Cell Carcinoma - Risk Factors

Excessive and cumulativeLifelong exposure to ultraviolet radiation is a major risk factor for the development of squamous cell carcinoma of the skin.It is influenced by both sun exposure and the use of a tanning bed.

In additionlong-term exposure to carcinogenic chemicalssuch as tobacco smoke or arsenic can lead to the development of squamous cell carcinoma of the skin.

Other risk factorsare:

  • genetic predisposition, e.g. people with parchment skin (Latin xeroderma pigmentosum)
  • old age
  • male gender
  • light complexion; however, regardless of the color of the skin, anyone can get squamous cell carcinoma
  • actinic keratosis or senile keratosis
  • severe sunburn e.g. in childhood or adolescence
  • presence of chronically ulcerative skin lesions
  • human papillomavirus (HPV) infections, especially in the genital area

It is also worth noting thatthe presence of reduced immunity (immunosuppression) significantly increases the risk of skin squamous cell carcinoma . Such people include patients with leukemias, lymphomas and people taking medications that weaken the systemimmune function, e.g. after organ transplantation.

Squamous cell carcinoma of the skin - how is it formed?

The cause of the development of squamous cell carcinoma of the skin is the abnormal multiplication of skin cells(keratinocytes). Molecular studies have shown that this phenomenon is based ongenetic mutations , e.g. in the gene encoding the p53 protein.

Mutations cause cells to grow uncontrollably and resist programmed death. They arise as a result of excessive exposure to ultraviolet radiation, which damages DNA, and the failure of DNA repair systems.

However, this does not explain the presence of squamous cell carcinoma of the skin in areas not exposed to ultraviolet radiation. Hence, it is believed that the condition of our immune system is also of great importance in the development of this type of cancer.

Squamous cell carcinoma of the skin - symptoms

Squamous cell carcinoma of the skin usually looks harmless and is characterized by slow growth. For this reason, it is very often underestimated by patients and diagnosed too late.

Actinic keratosis is a precancerous lesionthat can transform into squamous cell carcinoma of the skin, and early diagnosis and treatment will avoid the disease.

Whereasearly form of squamous cell carcinoma of the skinis the so-calledin situ skin squamous cell carcinoma , also known asBowen's disease .

Squamous cell carcinoma of the skin can take many forms. It may look like a lump, plaque, or hard nodules with a smooth, scaly, purulent, or ulcerated surface.

The color of the lesion may be red, it may also be iridescent. In addition,skin squamous cell carcinoma can often be asymptomaticand the affected area may be itchy or tender.

Although it does not look like skin cancer at first glance, squamous cell carcinoma of the skin is actually very dangerous as it can metastasize to nearby lymph nodes and tissues.

Squamous cell carcinoma of the skin - where does it occur?

Squamous cell carcinoma of the skin occurs mainly on skin that is exposed to sunlight . Therefore, the most common areas where squamous cell carcinoma appears are:

  • face,
  • upper surface of the auricle,
  • neck,
  • hairless top of the head,
  • forearm,
  • back of hand
  • and shave.

However, it can occur anywhere on the body, including the mouth, the soles of the feet, andon the genitals.

The appearance of squamous cell carcinoma of the skin in areas not exposed to the sun is more common in people with dark skin.

Skin squamous cell carcinoma - diagnosis

Skin biopsy is compulsory for all patients suspected of having squamous cell carcinoma of the skin. For this purpose, the doctor takes a lesion, and the method of biopsy will depend on the size and location of the lesion.

Histopathologically, squamous cell carcinoma of the skin is characterized by irregular sockets, ropes and lobes of neoplastic keratinocytes attacking the dermis.

The division of skin squamous cell carcinoma includesfour histological typesdepending on the degree of nucleus atypia and keratinization (keratinization):

  • squamous cell carcinoma of the skin well-differentiated
  • moderately differentiated skin squamous cell carcinoma
  • poorly differentiated skin squamous cell carcinoma
  • squamous cell carcinoma of the skin highly undifferentiated

The vast majority of squamous cell carcinomas of the skin are well treated surgically. However, there is a subgroup with specific histological and clinical features that show an increased risk of local recurrence and metastasis.

In this case, after diagnosis, it should be assessed whether the cancer has caused metastasis to the surrounding lymph nodes and tissues. For this purpose, ultrasound and / or biopsy of nodes, as well as chest X-ray and ultrasound of the abdominal cavity are performed.

Squamous cell carcinoma of the skin - treatment

The primary treatment method for skin squamous cell carcinoma is itssurgical excision with a margin of he althy skin . Mohs micrographic surgery is used in the diagnosis of invasive squamous cell carcinoma of the skin.

In patients who were not classified for surgical excision of the lesion,radiotherapyis used. In addition, radiotherapy is used as an adjunct therapy after skin squamous cell carcinoma excision, usually for very large tumors.

Chemotherapysystemic, such as treatment with oral 5-fluorouracil (5-FU) inhibitors, is used as a supplementary treatment in patients at high risk of metastasis.

In addition, in the treatment of squamous cell carcinoma of the skin,surface chemotherapye.g. 5-fluorouracil ointment or local treatment with laser therapy, cryotherapy, electrocoagulation.

Patients diagnosed with squamous cell carcinoma of the skin should be regularly examined and remember to use radiation protection measuresultraviolet.

Skin squamous cell carcinoma - prevention

In most cases, SCC can be prevented by:

  • avoiding overexposure to the sun's rays
  • avoiding tanning beds
  • using sunscreen
  • wearing protective clothing
  • regularly check for new skin growths or changes in existing moles, freckles and birthmarks
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Category:

Oncology