From the Guidelines
Squamous cell carcinoma (SCC) typically presents with a firm, red nodule or a flat lesion with a scaly, crusted surface that doesn't heal, often appearing on sun-exposed areas like the face, ears, neck, lips, and backs of hands. The signs of SCC can vary, but common presentations include:
- A firm, red nodule or a flat lesion with a scaly, crusted surface that doesn't heal
- An open sore that bleeds or crusts
- A wart-like growth
- A raised area with a central depression
- Changes in existing scars or chronic sores, which can indicate malignant transformation These lesions often grow slowly but persistently and may be tender or painful to touch 1. In advanced cases, SCC can cause local tissue destruction, invade deeper structures, or spread to lymph nodes, appearing as firm, enlarged nodes in the neck or other regions 1. People with fair skin, extensive sun exposure history, immunosuppression, or previous skin cancers should be particularly vigilant, as early detection is crucial for effective treatment 1. It's essential to note that SCC can develop on any skin surface, and awareness is growing that patients with skin of color are also at risk, with tumors sometimes emerging in sun-protected sites or areas of chronic inflammation 1. The presence of ulceration, bleeding, or a nodule can indicate transformation to invasive carcinoma, especially in lesions like those found in the nail unit 1. Given the potential for SCC to become invasive and metastasize if left untreated, it's critical to prioritize early detection and treatment, especially in high-risk individuals 1.
From the Research
Signs of Squamous Cell Carcinoma (SCC)
The signs of squamous cell carcinoma (SCC) can vary, but some common characteristics include:
- A painless plaque-like or verrucous tumor that can ultimately progress to being large, necrotic, and infected 2
- Tumors can also present with paresthesias or lymphadenopathy depending on the location involved 2
- SCC can arise de novo or be the result of a progression of the actinic keratosis, an in situ carcinoma 3
- The initial lesions of a cSCC tumor can present as a painless plaque-like or verrucous tumor 2
Clinical Presentation
The clinical presentation of SCC can include:
- A tumor that extends beyond the basement membrane and has high-risk features associated with sub-clinical metastasis 2
- High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple cSCC tumors, and immunosuppression 2
- Epidermal growth factor receptor and nuclear active IκB kinase (IKK) expression are also predictive of metastatic capabilities 2
Diagnosis
Diagnosis of SCC can be made using: