Squamous Cell Carcinoma Pathology
Squamous cell carcinoma is common form of keratinocytic skin cancer, usually related to exposure to ultraviolet radiation from sunlight. It often arises within solar/actinickeratosis or within squamous cell carcinoma in situ.
Perineural Or Vascular Invasion
In SCC, look for any perineural invasion, and at least a quick glance for any vascular invasion.
Perineural invasion: the arrow indicates a large peripheral nerve that has been surrounded by tumor cells.
Vascular invasion: the arrow indicates a small cluster of atypical squamous cells in a small vessel.
Vascular invasion most frequently involves a complete encircling of the nerve or vessel by tumor cells. An incomplete, crescent-like pattern of atypical cells is also commonly seen. Occasionally, tangential contact, permeation, and lamination can be observed. Invasion almost always occurs contiguous to the main body of the tumor however, it has been known on occasion to affect more distant nerve and vascular sites. Usually, tumor cells arranged in solid or sheet-like patterns are less invasive, and will pass around the nerve or vessel. In contrast, individual tumor cells will generally penetrate and track along associated structures.
What Are The Different Types Of Squamous Cell Carcinoma
People assume there is just a single type of squamous cell carcinoma, but there are actually several different types. Some are more likely to spread than others, but in general, most types share similar characteristics. The primary difference between the following types is related to the unique characteristics of the cancerous cells.
The primary types of squamous cell carcinoma are:
- Adenoid/pseudoglandular squamous cell carcinoma
- Small cell keratinizing squamous cell carcinoma
- Spindle cell squamous cell carcinoma
- Verrucous squamous cell carcinoma
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Electronic Skin Surface Brachytherapy
Some skin cancers that do not require very deep radiation may be treated with a new form of radiation therapy applied directly to the skin, called electronic skin surface brachytherapy .
In ESSB, we apply smooth, round disks to the skin these disks are attached to a radiation therapy machine. They are left in place for just a few minutes while the radiation is delivered, allowing the tumor to be treated. The approach spares underlying healthy skin from the effects of the radiation.
What Are The Signs Of Squamous Cell Carcinoma
Squamous cell carcinomas are more typical on sun-exposed skin: the scalp, the backs of the hands, the ears, and the lips. But this form of skin cancer can spread anywhere on your body.
Squamous cell carcinomas will have these characteristics:
- A firm, red nodule
- A flat sore with a scaly crust
- A new sore or raised area on an old scar
- A rough, scaly patch on your lip that can become an open sore
- A red sore or rough patch inside your mouth
- A red, raised patch or wart-like sore on or in the anus or on the genitals
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What Are The Signs And Symptoms Of Squamous Cell Carcinoma Of Tongue
The signs and symptoms of Squamous Cell Carcinoma of Tongue include:
- In majority of the cases, the condition is asymptomatic and does not present any signs or symptoms
- Generally, squamous cell carcinomas are slow-growing tumors though SCC of Tongue is an aggressive form of cancer
- The skin lesions may appear as crusted ulcer, plaques, and nodules
- It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
- The size of the lesions range from 1-10 cm average size is usually less than 3 cm
- Individuals with immunocompromised states have more aggressive tumors
- Due to the presence of the tongue lesion, it may be difficult for the individual to consume food and drink. Also, speaking may be difficult and painful
Head And Neck: Squamous Cell Carcinoma: An Overview
|Audrey Rousseau, Cécile Badoual
|Universite d’Angers, Departement de Pathologie Cellulaire et Tissulaire, CHU Angers, 4 rue Larrey, 49100 Angers, France Universite Rene Descartes Paris 5, Service d’Anatomie Pathologique, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
|8070/3 Squamous cell carcinoma, NOS
|Head and Neck::Squamous cell carcinoma
|Head and Neck
|Head and neck squamous cell carcinoma develops from the mucosal linings of the upper aerodigestive tract, comprising 1) the nasal cavity and paranasal sinuses, 2) the nasopharynx, 3) the hypopharynx, larynx, and trachea, and 4) the oral cavity and oropharynx. Squamous cell carcinoma is the most frequent malignant tumor of the head and neck region. HNSCC is the sixth leading cancer by incidence worldwide. There are 500000 new cases a year worldwide. Two thirds occur in industrialized nations. HNSCC usually develops in males in the 6th and 7th decade. It is caused by tobacco and alcohol consumption and infection with high-risk types of human papillomavirus . SCC often develops from preexisting dysplastic lesions. The five-year survival rate of patients with HNSCC is about 40-50%.
|Clinics and Pathology
The Ljubljana classification of squamous intraepithelial lesions has also been proposed .
2005 WHO Classification
Carcinoma in situ
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What Is Invasive Squamous Cell Carcinoma
Invasive squamous cell carcinoma is a type of cancer that occurs in the flat cells that make up the outer layer of skin and the linings of some organs, known as squamous cells. In this case, the word invasive means that the cancerous tumor has penetrated deeply into the skin or organ, as opposed to remaining a surface lesion. For example, in cases of invasive squamous cell carcinoma of the skin, the tumor may have penetrated into the dermis through the epidermis. Depending on the location, size, and severity of the tumor, there are several different courses of treatment that may be pursued.
Squamous cell carcinoma is the second most common type of skin cancer after basal cell carcinoma. Most often it is caused by exposure to UV rays, either through natural sunlight or by indoor tanning. People with fair skin are particularly susceptible. It can also occur in organs as diverse as the prostate, bladder, and larynx, although these are nowhere near as common as squamous cell skin cancer. Exposure to radiation or chemical carcinogens, as well as some inflammatory or scarring disorders, can also increase the risk of squamous cell cancer.
Squamous Cell Carcinoma Treatment
Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. However, left untreated, they may grow to the point of being very difficult to treat.
A small percentage may even metastasize to distant tissues and organs. Your doctor can help you determine if a particular SCC is at increased risk for metastasis and may need treatment beyond simple excision.
Fortunately, there are several effective ways to treat squamous cell carcinoma. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patients age and general health. Squamous cell carcinoma treatment can almost always be performed on an outpatient basis.
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What Is Squamous Cell Carcinoma Of Tongue
- Squamous Cell Carcinoma of Tongue is a common malignant tumor that typically affects elderly men and women. It is more aggressive than conventional squamous cell carcinoma affecting other body regions
- The cause of the condition is unknown, but genetic mutations may be involved. Factors that may influence its development include smoking and chewing of tobacco, radiation treatment for other reasons, and exposure to coal tar and arsenic
- The squamous cell carcinoma may appear as slow-growing skin lesions. The lesions may ulcerate and cause scarring of the tongue. It may be difficult to eat, swallow food, or even to speak
- The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. In majority of the cases, the prognosis is good with appropriate treatment
- Nevertheless, the prognosis of Squamous Cell Carcinoma of Tongue depends upon many factors including the stage of the tumor and health status of the affected individual. There is a possibility of local or regional metastasis, which can involve the lymph nodes. This may dictate the course of the condition
How Serious Is My Invasive Well
I have been diagnosed with “invasive well-differentiated squamous cell carcinoma, involving biopsy border”. How serious is this? It is located about one inch below ear and 1 inch diagonally below jawline. I also take an immunosuppressant for an unrelated condition, which I understand can make the cancer more serious. From what I have read, because of its location this is quite serious. Am I going to die?
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How Is Invasive Squamous Cell Carcinoma Of Anus Diagnosed
Some of the tests that may help in diagnosing Invasive Squamous Cell Carcinoma of Anus include:
- Complete physical examination with detailed medical history evaluation
- Examination by a dermatologist using a dermoscopy, a special device to examine the skin
- Skin or tissue biopsy: A skin or tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues and with microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out other similar conditions too
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
Tumour Staging For Cutaneous Scc
TX: Th Primary tumour cannot be assessed
T0: No evidence of a primary tumour
Tis: Carcinoma in situ
T1: Tumour 2cm without high-risk features
T2: Tumour 2cm or Tumour 2 cm with high-risk features
T3: Tumour with the invasion of maxilla, mandible, orbit or temporal bone
T4: Tumour with the invasion of axial or appendicular skeleton or perineural invasion of skull base
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What Is The Treatment For Advanced Or Metastatic Squamous Cell Carcinoma
Locally advanced primary, recurrent or metastatic SCC requires multidisciplinary consultation. Often a combination of treatments is used.
- Experimental targeted therapy using epidermal growth factor receptor inhibitors
Many thousands of New Zealanders are treated for cutaneous SCC each year, and more than 100 die from their disease.
How Is Squamous Cell Carcinoma Of Tongue Treated
Early diagnosis and treatment of Squamous Cell Carcinoma of Tongue is important to avoid complications such as metastasis to other regions. The treatment measures may include:
- In most cases, a wide surgical excision and removal of the entire tumor is the preferred treatment option . This may be followed by radiation therapy and/or chemotherapy
- If the tumor has metastasized , then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
- Targeted therapy medications are generally used for locally infiltrated or metastatic SCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
- Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
- Follow-up care with regular screening and check-ups are important and encouraged
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What Is The Outlook For Cutaneous Squamous Cell Carcinoma
Most SCCs are cured by treatment. A cure is most likely if treatment is undertaken when the lesion is small. The risk of recurrence or disease-associated death is greater for tumours that are > 20 mm in diameter and/or > 2 mm in thickness at the time of surgical excision.
About 50% of people at high risk of SCC develop a second one within 5 years of the first. They are also at increased risk of other skin cancers, especially melanoma. Regular self-skin examinations and long-term annual skin checks by an experienced health professional are recommended.
What Causes Cutaneous Squamous Cell Carcinoma
More than 90% of cases of SCC are associated with numerous DNAmutations in multiple somaticgenes. Mutations in the p53 tumour suppressor gene are caused by exposure to ultraviolet radiation , especially UVB . Other signature mutations relate to cigarette smoking, ageing and immune suppression . Mutations in signalling pathways affect the epidermalgrowth factorreceptor, RAS, Fyn, and p16INK4a signalling.
Beta-genus human papillomaviruses are thought to play a role in SCC arising in immune-suppressed populations. -HPV and HPV subtypes 5, 8, 17, 20, 24, and 38 have also been associated with an increased risk of cutaneous SCC in immunocompetent individuals.
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Cancer Stage Determines Risk Of Spreading And Line Of Treatment
A cancer of the upper layers of the skin in the epidermis, SCC is the second most common form of skin cancer after basal cell carcinoma and affects an estimated 1 million new people every year in the United States alone. Cancer staging is done for SCC with the intention of categorizing the size of cancer and to judge how much it has grown. And theres a clear line of treatment and way forward for each stage.1
With skin cancers like basal cell carcinoma, the likelihood of cancer spreading to other parts of the body is very low and early diagnosis and treatment usually tackles the problem before it spreads. SCC, however, is a little trickier. While the risk of spreading is still quite small, there is a relatively higher chance of it progressing depending on what stage the cancer is at. For those with weakened immune systems, say, people whove had organ transplants or anyone infected with HIV, the risk is a little higher. Also, when the cancer is in the head and neck region, it may have a slightly higher risk of recurring or spreading.2
The actual stage of this form of cancer is determined based on the TNM protocol devised by the American Joint Commission on Cancer.3
- T : The size/extent of the tumor
- N : Whether it has spread to lymph nodes
- M : Whether it has spread to other parts of the body
What Causes Squamous Cell Carcinomas
Squamous cell carcinomas of the skin develop when the flat, thin squamous cells in the outer layer of the skin develop errors in their DNA. In ordinary, healthy skin, new cells push older cells toward the skin surface, where they die and are shed. When the DNA is damaged, the squamous cells instead grow out of control, forming a squamous cell carcinoma.
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What Is The Outlook For Someone Who Has Squamous Cell Carcinoma Of The Skin
When found early, this cancer is highly treatable. Left untreated, however, SCC can spread deep into the skin and travel to other parts of the body, making treatment difficult.
While treatment can remove the cancer, its important to know that this cancer can return. You also have a greater risk of developing another skin cancer.
Thats why self-care becomes so important after treatment for SCC of the skin. Youll find the self-care that dermatologists recommend at, Squamous cell carcinoma of the skin: Self-care.
ReferencesAlam M, Armstrong A, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018 78:560-78.
Anadolu-Brasie R, Patel AR, et al., Squamous cell carcinoma of the skin. In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 86-114.
Marrazzo G, Zitelli JA, et al. Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone. J Am Acad Dermatol 2019 80:633-8.
Que SKT, Zwald FO, et al. Cutaneous squamous cell carcinoma: Management of advanced and high-stage tumors. J Am Acad Dermatol 2018 78:249-61.
Ribero S, Stucci LS, et al. Drug therapy of advanced cutaneous squamous cell carcinoma: Is there any evidence? Curr Opin Oncol. 2017 29:129-35.
U.S. Food and Drug Administration. FDA approves cemiplimab-rwlc for metastatic or locally advanced cutaneous squamous cell carcinoma. New release issued 9/28/2018. Last accessed 1/13/2020.
Basal Cell Carcinoma Stages
There are certain features that are considered to make the cancer at higher risk for spreading or recurrence, and these may also be used to stage basal cell carcinomas. These include:
- Greater than 2 mm in thickness
- Invasion into the lower dermis or subcutis layers of the skin
- Invasion into the tiny nerves in the skin
- Location on the ear or on a hair-bearing lip
After the TNM components and risk factors have been established, the cancer is given a stage. For basal cell carcinoma staging, the factors are grouped and labeled 0 to 4. The characteristics and stages of basal cell carcinoma are:
Stage 0: Also called carcinoma in situ, cancer discovered in this stage is only present in the epidermis and has not spread deeper to the dermis.
Stage 1 basal cell carcinoma: The cancer is less than 2 centimeters, about 4/5 of an inch across, has not spread to nearby lymph nodes or organs, and has one or fewer high-risk features.
Stage 2 basal cell carcinoma: The cancer is larger than 2 centimeters across, and has not spread to nearby organs or lymph nodes, or a tumor of any size with 2 or more high-risk features.
Stage 3 basal cell carcinoma: The cancer has spread into facial bones or 1 nearby lymph node, but not to other organs.
Stage 4 basal cell carcinoma: The cancer can be any size and has spread to 1 or more lymph nodes which are larger than 3 cm and may have spread to bones or other organs in the body.
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