Squamous cell carcinoma and precursors Flashcards

1
Q

What is squamous cell carcinoma?

A

A malignancy of the supra-basal keratinocytes of the epidermis

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2
Q

Where do squamous cell carcinomas most commonly occur?

A

On sun exposed sites (Face, ears, dorsal hands) in the elderly

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3
Q

What are some rarer locations of SCC formation?

A

Chronic leg ulcers (E.g. stasis ulcers)
Sites of burns
Sinuses
Areas affected by chronic lupus vulgaris

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4
Q

What are some conditions associated with SCC?

A

Xeroderma pigmentosum
Dystrophic variant epidermolysis bullosa

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5
Q

What is the spectrum of disease leading to SCC?

A

Actinic keratosis (Mildest)
Bowen’s disease
Squamous Cell Carcinoma

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6
Q

What is actinic keratosis?

A

A partial thickness, keratinocyte dysplasia of the epidermis

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7
Q

What is Bowen’s disease?

A

A full thickness, keratinocyte dysplasia of the epidermis

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8
Q

Where do actinic keratoses most commonly form?

A

Sun-exposed areas (Scalp, face, hands)

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9
Q

Describe the histology of actinic keratosis

A

Presence of parakeratin (Nucleated cells) in the keratin layer shows fast turnover

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10
Q

Where does Bowen’s disease most commonly form?

A

Lower leg
Females

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11
Q

How will Bowen’s disease present on the skin?

A

Scaly plaque or patch with an irregular border

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12
Q

How will Bowen’s disease show on histology?

A
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13
Q

What condition is shown?

A

Actinic keratosis

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14
Q

What condition is shown?

A

Bowen’s disease

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15
Q

What is a viral SCC precursor?

A

Penile Bowen’s disease (Erythroplasia of Queryat)

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16
Q

What virus can cause penile Bowen’s disease?

A

HPV type 16

17
Q

How will SCC present?

A

Fast growing (2-3 months) often tender scaly or ulcerated lesion

18
Q

What condition is shown?

A

Actinic keratosis

19
Q

What condition is shown?

A

Bowen’s disease

20
Q

What condition is shown?

A

Squamous cell carcinoma

21
Q

What condition is shown?

A

SCC - Common on bald scalps due to sun damage, plus previous excision scar on the left, so highly suggestive of SCC

22
Q

What condition is shown?

A

SCC - Ears and lips are common sites of sun damage due to forgetting to apply sun cream there, also increased risk of metastases

23
Q

What condition is shown?

A

SCC on leg ulcer

24
Q

What are some non-surgical treatments for SCC?

A

liquid nitrogen or cytotoxic cream (Efudix) can be used in superficial, non-life threatening lesions

25
Q

What are some adverse prognostic features of SCC?

A
  • Thickness > 4mm and poor differentiation
  • lymphatic / vascular space invasion
  • perineural spread
  • specific sites poorer prognosis - scalp, ear, nose
26
Q

How is SCC usually managed?

A

Surgical excision with a wide margin