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Patient Case: Squamous Cell Carcinoma (SCC)

Patient Case: Squamous Cell Carcinoma (SCC)

Discussion

A 68-year-old retired construction worker presents to the dermatology clinic with a non-healing sore on his left forearm. He first noticed a rough, scaly patch in the same area about a year ago, which he assumed was dry skin. Over time, the lesion grew larger, became thicker, and eventually ulcerated. It now frequently bleeds and forms a crust.

The patient has a history of significant sun exposure due to his outdoor job, with frequent sunburns in the past. He has fair skin, multiple actinic keratoses on his scalp and arms, and a history of smoking for 30 years.

On examination, there is a firm, erythematous, scaly plaque with an ulcerated center on the dorsal forearm. The lesion is tender to palpation, with indurated edges. A punch biopsy confirms invasive squamous cell carcinoma (SCC).

The patient is counseled on treatment options, including wide local excision, Mohs micrographic surgery, and possible lymph node evaluation for high-risk features. He is advised on strict sun protection and the need for regular skin surveillance due to the risk of recurrence and metastasis.

Questions
  1. What is the primary risk factor for developing squamous cell carcinoma?
    a) Chronic sun exposure and ultraviolet (UV) radiation
    b) Viral infections such as herpes simplex virus
    c) Deficiency of essential fatty acids
    d) Excessive consumption of sugary foods
  2. Which clinical feature is most characteristic of squamous cell carcinoma?
    a) A pearly nodule with telangiectasia and rolled borders
    b) A scaly, erythematous plaque or ulcer with induration
    c) A smooth, well-demarcated pigmented lesion
    d) A cluster of painful vesicles on an erythematous base
  3. Which treatment is most appropriate for high-risk squamous cell carcinoma?
    a) Cryotherapy
    b) Topical steroids
    c) Wide local excision or Mohs micrographic surgery
    d) Antiviral medications
  4. Why is early diagnosis and treatment of SCC important?
    a) It has a high potential for metastasis if untreated
    b) It is highly contagious and spreads between individuals
    c) It often resolves on its own without treatment
    d) It causes only cosmetic concerns with no long-term effects
Reveal answers

Answers

  1. (a) Chronic sun exposure and ultraviolet (UV) radiation
    • SCC is strongly linked to cumulative sun exposure, particularly in individuals with fair skin, outdoor occupations, or a history of frequent sunburns.
  2. (b) A scaly, erythematous plaque or ulcer with induration
    • SCC typically presents as a rough, scaly lesion that may ulcerate and bleed. Induration and tenderness are common features.
  3. (c) Wide local excision or Mohs micrographic surgery
    • Surgical excision is the preferred treatment for SCC. Mohs surgery is especially useful for high-risk lesions in cosmetically sensitive or functionally critical areas.
  4. (a) It has a high potential for metastasis if untreated
    • Unlike basal cell carcinoma, SCC has a greater risk of spreading to lymph nodes and distant organs, especially in immunocompromised patients or if it arises on high-risk sites like the lips, ears, or genitalia.