SCC vs nodular prurigo

Squamous cell carcinoma

Squamous cell carcinoma  

Presentation 

  • 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.

Diagnosis

  • Incisional biopsy will confirm the diagnosis and determine the degree of differentiation within the tumour, which may affect the management.

Treatment

  • 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).

Nodular prurigo

Presentation

  • - 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

Aetiology

  • Localised trauma to the skin from scratching.
  • Lesion is benign with malignant transformation extremely unlikely.

Treatment

  • 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.

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