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

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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

Nov 17, 2023 306 likes •624 views

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

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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

Diagnosis of Cutaneous SCC

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INTRODUCTION

 Aim : Increased confidence screening for SCC  Encourage follow up care in the community

especially for low risk tumours

1.

Diagnosis

  • 2. Management

3.

Follow up/Screening

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Importance of SCC’s

1.

NMSC is the most common group of cancers

  • 2. 23% of these are SCC’s

3.

Continuing increase in prevalence

  • 4. Cancer of cells producing keratin

5.

May metastasise so treat early

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Risk factors

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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

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History

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

invasion

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Examination

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

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Location

 Within a background of

sun-damaged skin

 Sun exposed sites 1.

Bald scalp

  • 2. Face
  • 3. Neck
  • 4. Extensor forearms
  • 5. Dorsal hands
  • 6. Shin
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A few mm Flesh coloured Several cm Erythematous

Size and colour variable

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Initially thickening of skin and becomes an indurated plaque

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Papulonodular

Gradually becomes fixed and nodular

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Papulonodular

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Keratin/’Crater’

Margin firm and more raised than a basal cell carcinoma, often everted and irregular

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Plaque like

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Surface can be

  • Crusted
  • Eroded
  • Ulcerated
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Warty/keratin horn

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Poorly differentiated

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Arising within ulcers

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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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 Thank you

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Risk factors

 UV radiation – SCC relate to chronic exposure (outdoor

  • ccupation/recreation)

 Sun – lived abroad>holidays  Sunbeds  Fair skin, red hair, blue eyes  Family history  Immunosuppression (HIV, drugs, blood malignancies,

  • rgan transplant, receiving radiation)

 BCC/AK’s  Smoking  Previous cutaneous injury – longstanding ulcer/thermal

injury

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Examination

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