Squamous cell carcinoma of the skin history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

Squamous cell carcinoma is a cutaneous tumor, which can be diagnosed in very early stages itself. Early diagnosis of the condition makes it amendable for treatment.

History / Presenting complaints

It is easy to find it as it appears mostly in the noticeable regions of the body like face, ears, neck, arms, etc. It grows slowly and presentation depends on the part of the body that is involved. It may vary from simple growing lump , plaque or a bleeding ulcer.

Systemic symptoms of this carcinoma are seen in the advanced stages where the cancer disseminates causing easy fatigability. But few symptoms like dysphagia, odynophagia are seen when tongue, lips or esophagus are involved.

Skin

Persons who present with Squamous cell carcinoma of skin may have one of the following risk factors like

• significant sun exposure
• benign lesions like Chalazion
• chronic ulcers.

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  Squamous cell skin cancer.

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  Squamous cell carcinoma in oral cavity.
  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  This patient had two adjacent cancers. The flat black lesion below the antitragus is a malignant melanoma. The white elevated keratotic lesion is a squamous cell carcinoma .

Presentation : They usually notice plaque. Ulcers are commonly seen over the face causing disfiguration. At times they can be exophytic over the lips etc.

Tongue and Esophagus

Persons who present with Squamous cell carcinoma of tongue and esophagus are most likely to have following risk factor

• Tobacco chewing/smoking
• Alcohol Abuse
• Poor dental hygiene

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  Squamous cell carcinoma in oral cavity.
  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  A large squamous cell carcinoma of the tongue

Presentation : Its usually ulcerated in the lateral part of the tongue, pink - red color. Patient finds tough to eat or swallow. As it bleeds on touch or biting. They have dysphagia/ odynophagia when esophagus is involved. In later stages even liquids are tough to go thru. Swelling of lymph nodes is seen in advanced stages where we can find lumps in the neck

Nasopharynx

Persons who have SCC of this region seldom have any risk factors. It most of the times caused by EBV infection.

Presentation : Patient presents with symptoms from the mass effect of the tumour. They include nasal discharge, bleeding, obstruction; ear infection, deafness , tinnitus are complained. Other important complaints include headache and neck swelling due to lymph nodal spread.

Lungs

Persons who have SCC of lungs usually have risk factors like

• Therapeutic radiation (PUVA for psoriais)
• Tobacco smoking

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  Biopsy of a highly differentiated squamous cell carcinoma of the mouth.Haematoxylin & eosin stain.

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  Photograph of a squamous cell carcinoma. Tumour is on the left, obstructing the bronchus (lung). Beyond the tumour the bronchus is inflammed and contains mucus

Presentation : Persons who present with SCC of lungs doesn't present usually with any typical symptoms of pulmonary. But in few we may see persistent cough, hemoptysis when it is exophytic and occupies whole of the bronchi which can even lead to recurrent infections.

Penis

Persons who present with Squamous cell carcinoma of penis are most likely to have

• Pre-malignanat lesions (Bowen's disease, Condyloma , Warts)
• Smoking and tobacco chewing

Presentation : Unhealed lesions, subtle indurations may be the intial presentation. Often presentation to the clinic is delayed due to embarrassment most of the times. Warts can be a pre-disposing factor.Large warts lead to infections and necrosis leading to hemorrhages at times.

References

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