Diagnosis of Cutaneous SCC D R V H O G A R T H D E R M A T O L O - PowerPoint PPT Presentation

Diagnosis of Cutaneous SCC D R V H O G A R T H D E R M A T O L O G Y C O N S U L T A N T K I N G S T O N H O S P I T A L

INTRODUCTION  Aim : Increased confidence screening for SCC  Encourage follow up care in the community especially for low risk tumours Diagnosis 1. 2. Management Follow up/Screening 3.

Importance of SCC’s NMSC is the most common group of cancers 1. 2. 23% of these are SCC’s Continuing increase in prevalence 3. 4. Cancer of cells producing keratin May metastasise so treat early 5.

Risk factors

Immunosuppression  HIV  Immunosuppressive drugs  Blood malignancies  Organ transplant  Receiving radiation  These are more aggressive and greater risk of metastasis  Previous cutaneous injury – longstanding ulcer/thermal injury

History  Varies  Enlarging over weeks to months  Rapidly growing with pain and tenderness  Pain is important because it can indicate perineural invasion

Examination  Size  Location  ?recurrent  ?connected to underlying structures  Borders – well/poorly defined  ?evidence of previous surgery  Lymph nodes  Full skin examination

Location  Within a background of sun-damaged skin  Sun exposed sites Bald scalp 1. 2. Face 3. Neck 4. Extensor forearms 5. Dorsal hands 6. Shin

Size and colour variable A few mm Several cm Flesh coloured Erythematous

Initially thickening of skin and becomes an indurated plaque

Papulonodular Gradually becomes fixed and nodular

Papulonodular

Keratin/’Crater’ Margin firm and more raised than a basal cell carcinoma, often everted and irregular

Plaque like

Surface can be • Crusted Eroded • • Ulcerated

Warty/keratin horn

Poorly differentiated

Arising within ulcers

High risk features  Ears, lips, genitalia and other mucosal sites  Greater than 2cm  Tumour thickness greater than 4mm  Moderate or poorly differentiation  Perineural invasion  Recurrent  Arising form a scar or ulcer  Lymphovascular invasion  Immunosuppression

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Risk factors  UV radiation – SCC relate to chronic exposure (outdoor occupation/recreation)  Sun – lived abroad>holidays  Sunbeds  Fair skin, red hair, blue eyes  Family history  Immunosuppression (HIV, drugs, blood malignancies, organ transplant, receiving radiation)  BCC/AK’s  Smoking  Previous cutaneous injury – longstanding ulcer/thermal injury

Examination  A Less commonly plaque-like or warty  Can be hyperkeratotic with thick crust  Secondary changes include erosions and ulceration