Ulcerating squamous cell carcinoma
Ulcerating squamous cell carcinoma (SCC) is a common non-melanotic skin cancer, second in frequency only to basal cell carcinoma (BCC). It occurs as the result of malignant transformation of epidermal keratinocytes, invades local tissues and has the potential to metastasize.
If this diagnosis is suspected, urgent referral should be made to a dermatologist or surgeon for confirmation by biopsy and treatment; surgical excision, when possible, is the treatment of choice. For tumours where excision is not felt to be possible of if the patient is unwilling to accept surgery, radiotherapy may be offered as an alternative. Cryotherapy or curettage and cautery (C&C) should be considered only for small, low risk tumours.
This 76 year old woman (left) presented with an ulcerating lesion on her hand, measuring 3cm in diameter; it had increased in size rapidly over the preceding two months. Due to the size of the lesion she was referred to a plastic surgeon as grafting would probably be necessary after its removal. Histology confirmed the diagnosis and complete excision was achieved with a satisfactory margin.
Predisposing factors: Bowen's disease
Most SCC develop in the elderly, being more common in men, particularly those with blue eyes, fair hair and fair skin that readily burns in the sun and have, over the years been frequently exposed to ultraviolet radiation.