Squamous cell carcinoma
Squamous cell carcinoma: Excerpt from Handbook of Diseases
Arising from the keratinizing epidermal cells, squamous cell carcinoma of the skin is an invasive tumor with metastatic potential. It occurs most often in fair-skinned white men older than age 60. Outdoor employment and residence in a sunny, warm climate (southwestern United States and Australia, for example) greatly increase the risk of developing squamous cell carcinoma.
Causes
Predisposing factors associated with squamous cell carcinoma include overexposure to the sun’s ultraviolet rays and the presence of premalignant lesions (such as actinic keratosis or Bowen’s disease).
Other predisposing factors include X-ray therapy, ingestion of herbicides containing arsenic, chronic skin irritation and inflammation, burns or scars, exposure to local carcinogens (such as tar and oil), and hereditary diseases (such as xeroderma pigmentosum and albinism). Rarely, squamous cell carcinoma may develop on the site of smallpox vaccination, psoriasis, or chronic discoid lupus erythematosus.
Signs and symptoms
Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Early lesions appear as opaque, firm nodules with indistinct borders, scaling, and ulceration. Later lesions become scaly in appearance from keratinization and are most common on the face and hands (sun-exposed areas). Lesions on sun-damaged skin tend to be less invasive and less likely to metastasize than lesions on unexposed skin.
Notable exceptions to this tendency are squamous cell lesions on the lower lip and the ears. These are almost invariably markedly invasive metastastic lesions with a generally poor prognosis.
Transformation from a premalignant lesion to squamous cell carcinoma may begin with induration and inflammation of the preexisting lesion. When squamous cell carcinoma arises from normal skin, the nodule grows slowly on a firm, indurated base.
If untreated, this nodule eventually ulcerates and invades underlying tissues. Metastasis can occur to the regional lymph nodes, producing characteristic systemic symptoms of pain, malaise, fatigue, weakness, and anorexia.
Diagnosis
An excisional biopsy offers definitive support for a diagnosis of squamous cell carcinoma. Other appropriate laboratory tests depend on systemic symptoms.
Treatment
The size, shape, location, and invasiveness of a squamous cell tumor and the condition of the underlying tissue determine the treatment method used.
Premalignant lesions respond well to treatment. (See Treating actinic kera-toses.) A deeply invasive tumor may require a combination of techniques.
All the major treatment methods have excellent cure rates; the prognosis is usually better with a well-differentiated lesion than with a poorly differentiated one in an unusual location.
Depending on the lesion, treatment may consist of:
❑ surgical excision
❑ electrodesiccation and curettage (which offer good cosmetic results for small lesions)
❑ radiation therapy (generally for elderly or debilitated patients)
❑ chemosurgery (reserved for resistant or recurrent lesions).
Special considerations
❑ Keep the wound dry and clean.
❑ Tell the patient to use lip screens to protect the lips from sun damage.
❑ To prevent squamous cell carcinoma, tell the patient to avoid excessive sun exposure and wear protective clothing (hats, long sleeves).
❑ Instruct the patient to periodically examine the skin for precancerous lesions and have any removed promptly.
❑ Advise the patient to use sunscreen containing para-aminobenzoic acid, benzophenone, and zinc oxide. He should apply these agents 30 to 60 minutes before sun exposure.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Bowen's disease
More Medical Textbooks Online about Bowen's disease
Review other book chapters online related to Bowen's disease:
Medical Books Excerpts
- Skin, scaly
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, scaly
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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Skin, scaly (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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