Clinical Presentation of Squamous Cell Carcinoma
Yes, squamous cell carcinoma (SCC) characteristically presents with central ulceration and crust formation as one of its hallmark clinical features. 1
Typical Clinical Presentations
SCC typically manifests in two distinct patterns:
Keratinizing/crusted nodular tumor with ulceration: The most common presentation is an indurated nodular keratinizing or crusted tumor that may ulcerate 1, 2
Pure ulcerative form: Alternatively, SCC may present as an ulcer without evidence of keratinization 1
Firm hyperkeratotic lesions: Can also appear as a firm, smooth, or hyperkeratotic papule or plaque with central ulceration 3
Key Diagnostic Features to Recognize
When evaluating suspected SCC, look specifically for these clinical characteristics:
Indurated (firm) base: The lesion feels hard to palpation, distinguishing it from benign inflammatory processes 1
Nodular growth pattern: Raised, three-dimensional appearance rather than flat 1
Surface keratinization: Thick, adherent crust or scale formation 1, 3
Central ulceration: Break in the epithelial surface, often with raised or rolled edges 3
Arborizing telangiectasias: May be present on the surface (though more characteristic of basal cell carcinoma) 3
High-Risk Presentations Requiring Urgent Attention
In patients with chronic wounds or epidermolysis bullosa, be especially vigilant for these warning signs:
Non-healing wound lasting ≥4 weeks (longer than typical wound healing) 1
Rapidly growing wound with heaped-up appearance resembling exuberant granulation tissue 1
Deep, punched-out ulcer with raised or rolled edges 1
Hyperkeratotic area surrounded by a shoulder of raised skin 1
Altered sensation (tingling or increased pain) relative to baseline 1
Common Clinical Pitfall
Do not dismiss crusted, ulcerated lesions as simple inflammatory conditions or chronic wounds. The presence of persistent crusting with ulceration in sun-exposed areas of fair-skinned individuals, especially those over age 60, should prompt biopsy to exclude SCC 1, 4. In immunosuppressed patients or those with chronic wounds, maintain an even lower threshold for tissue diagnosis, as SCC in these populations behaves more aggressively 1.
Definitive Diagnosis
Always obtain histopathologic confirmation via biopsy before initiating treatment, as clinical appearance alone is insufficient for definitive diagnosis 1, 5. Use shave biopsy technique for raised lesions or punch biopsy of the most abnormal-appearing area 3.