Squamous Cell Carcinoma, Cutaneous

Squamous Cell Carcinoma, Cutaneous is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Cutaneous squamous cell cancer is a type of cancer that is very common. It is associated with some hereditary disorders like xeroderma pigmentosum, oculocutaneous albinism, epidermodysplasia verruciformis.

Epidemiology

Incidence
  • Occurs in older age (around 60 years) (1)
  • More common in men (1)
  • Incidence increases the closer the person gets to equator or higher altitude (1).

Prevalence
Average age it develops is 70 years.

Etiology and Pathophysiology

Genetics

Some of the hereditary disorders have the genes that are associated with cutaneous squamous cell cancer (2). They include:

  • Xeroderma pigmentosum (2)
  • Oculocutaneous albinism (2)
  • Epidermodysplasia verruciformis (2)
  • Genes commonly mutated includes:
    • TP53
    • CDKN2A
    • NOTCH1, Ras
    • TP53 is the most common gene involved in cutaneous squamous cell cancer.

Risk Factors

  • UV radiation exposure (2,3)
  • Increasing age (Average age of onset is mid-60s.)
  • Immunosuppression (2)
  • HIV/AIDS, non-Hodgkin lymphoma, chronic lymphocytic leukemia have increase rates of developing cutaneous squamous cell cancer (2).
  • Gender (more common in men)
  • Psoriasis patients treated with ultraviolet A (UVA)
  • Glucocorticoid use (2)
  • Postmenopausal hormonal use (2)
  • High body mass
  • Ionizing radiation exposure (3)
  • Chemical exposure (pesticides, PAH) (2)
  • Arsenic (2,3)
  • Organ transplantation (3)
  • Alcohol use (2)
  • Osteomyelitis (3)
  • Exposure to UV light (UVA and UVB)
  • Xeroderma pigmentosum (3)
  • Ulcers (3)
  • Chronically injured or diseased skin (3)
  • Actinic keratosis (2,3)
  • Radiation-induced keratosis (3)
  • Precursor lesions (3)
  • Bowen disease (squamous cell carcinoma [SCC] in situ) (3)
  • Erythroplasia of Queyrat (SCC in situ of penis) (3)
  • Leukemia (3)
  • Lymphoma (3)
  • Immunosuppression (3)
  • Organ transplantation (3)
  • Immunosuppressive medications (3)
  • HPV infection (6, 11, 16, 18) (3)

General Prevention

  • Protect skin from sun exposure (2).
  • Wear sunscreen, hats, and clothing under skin.
  • Vitamin B3 (nicotinamide) can repair DNA by preventing UVR-induced adenosine triphosphate depletion (2).
  • Difluoromethylornithine (synthetic analog of ornightine) (2)

Commonly Associated Conditions

  • Actinic keratosis is the precursor of cutaneous squamous cell cancer (1).
  • Diseases that evolve into squamous cell cancer include:
    • Bowen disease (1)
    • Erythroplasia of Queyrat (1)

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