Squamous cell carcinoma
- May occur in actinic keratoses, ulcers, scars, sinus tracks and on mucous membranes.
- Tend to increase in size with time, although some will grow rapidly.
- Much higher incidence in immunocompromised patients, especially those who are on long-term immunosuppressants such as after organ transplant
- More common on sun-exposed areas.
- Appearance very variable: often hyperkeratotic, but may occur as nodules or ulcers.
- Malignant tumour with the potential for metastatic spread if not treated properly.
- Incisional biopsy will confirm the diagnosis and determine the degree of differentiation within the tumour, which may affect the management.
- Wide excision is needed with histology to check for full excision.
- Radiotherapy is an alternative treatment option in those for whom surgery would not be appropriate, ie large tumours.
- Regular follow up to check for further new lesions and recurrences.
- Advice regarding avoiding further sun damage.
- Other areas of localised sun damage (actinic keratoses) likely to be present which can be treated (for example topical 5-fluorouracil, cryotherapy or solaraze).
- - Predominantly affects the extensor aspects of lower limbs and arms.
- Usually very itchy, with marked itch-scratch cycle.
- Chronic in nature.
- Discrete excoriated nodules.
- Hyperpigmentation may be present.
- Surface maybe crusted or scaly
- Localised trauma to the skin from scratching.
- Lesion is benign with malignant transformation extremely unlikely.
- Avoiding trauma to the area by scratching.
- Occluding the area to prevent scratching especially, if the affected area is a lower limb.
- Potent topical steroids may help.
Contributed by Dr Nigel Stollery, GP, Kibworth, Leicestershire and clinical assistant in dermatology at the Leicester Royal Infirmary.