Epidermoid carcinoma

Synonyms

Squamous cell carcinoma of the skin, Cutaneous Squamous Cell Carcinoma, cSCC,

Overview

* Squamous cell cancer (SCC) of the skin is the cancerous (i.e., malignant) transformation of the squamous cells (keratinocytes in skin), which normally cover the surface of the skin and other body parts (e.g., lungs, mouth, nose, throat) providing protection against outside forces (e.g., infections, injuries, sunlight). A malignant transformation means that these cancer cells are dividing rapidly without following the normal guidelines of cell division and maturation. Since the depletion of the ozone layer in the last century, harmful ultraviolet rays (UV) of the sun are passing through unfiltered, and are giving rise to more cases of skin cancer than ever before. SCC constitutes 20% of all skin cancers.
* Bowen’s Disease is subset of Actinic Keratosis or SCC in situ, appearing as a reddish skin patch. This is basically an early stage (in situ) SCC that has not spread beyond its point of origin. SCC almost always appears on the areas of the skin with the most exposure to sunlight such as the nose, lower lips, back of hands, forehead, neck, and ears. On rare occasions, there may be an appearance in the genital areas.

Symptoms

* There is often a red/pink firm bump
* Appear in areas with maximum sun exposure (scalp, forehead, neck, ear)
* May have a scaly and rough surface, but may appear smooth or wart like.
* The lesion may bleed easily
* May crust over
* May appear in other areas of the skin
* On moist surfaces (mouth, head of penis), it may appear as a whitish color (Leukoplakia).
* May be seen in areas of a previous scar or skin damage (e.g., venous insufficiency and ulceration).

Causes

* Chronic sun exposure –The UV rays, whether from sun or tanning salons, are harmful to the skin.
* Radiation exposure — such as those who have received radiation therapy
* Exposure to arsenic, often found in some insecticides
* Exposure to coal, tar and Paraffin
* Immunosuppression — weakened immune system from disease or treatments (such as drugs used for after organ transplantation).
* Prior Burns — SCC may appear on areas of a previous burn scar or other damaged skin. This is also known as Marjolin’s ulcer.
* Human papilloma virus may be responsible for a wart like variety of SCC.

Prevention

* The key is to reduce exposure to UV light. Choose the shade not light if you are planning to spend a long time outdoors.
* If out doors for extended periods of time, wear protective clothing and sunscreen (SPF >15) even during winter times.
* I recommend hats, long sleeve shirts and long pants since the effects of long-term use of sunscreen lotions and creams are still unknown
* Protect the children and elderly since their skin is more vulnerable.
* Report any suspicious lesion to your doctor
* Support legislation that helps to protect the ozone layer.

Diagnosis

* Often picked up on the examination of the skin
* Biopsy of the skin is the only method of diagnosis where a piece of the lesion is removed and examined under a microscope by a pathologist.

Treatment

* Surgery is the only treatment available at this time.
* Excision surgery is a simple excision and removal of the lesion
* Electrodessication and Curettage is best for lesions larger then 1.0 cm
* Cryosurgery — the killing of cells by freezing them.
* Micrographic and laser surgery are some of the other treatments
* 95% of all SCC are curable
* A small number spread to the surrounding areas as well as regional lymph nodes, and require more aggressive therapy.