Cutaneous squamous-cell carcinoma

Cutaneous squamous-cell carcinoma
Other namesSquamous-cell carcinoma of the skin, squamous-cell skin cancer, epidermoid carcinoma, squamous-cell epithelioma of the skin
Cutaneous squamous-cell carcinoma tends to arise from actinic keratoses (premalignant lesions); surface is usually scaly and often ulcerates (as shown here).
SpecialtyDermatology, plastic surgery, otorhinolaryngology
SymptomsHard lump with a scaly top or ulceration.[1]
Risk factorsUltraviolet radiation, actinic keratosis, tobacco smoking, lighter skin, arsenic exposure, radiotherapy, poor immune system function, HPV infection[2]
Diagnostic methodTissue biopsy[2][3]
Differential diagnosisKeratoacanthoma, actinic keratosis, melanoma, warts, basal cell cancer[4]
PreventionDecreased UV radiation exposure, sunscreen[5][6]
TreatmentSurgical removal, radiotherapy, chemotherapy, immunotherapy[2][7]
PrognosisUsually good[5]
Frequency2.2 million (2015)[8]
Deaths51,900 (2015)[9]

Cutaneous squamous-cell carcinoma (cSCC), also known as squamous-cell carcinoma of the skin or squamous-cell skin cancer, is one of the three principal types of skin cancer, alongside basal-cell carcinoma and melanoma.[10] cSCC typically presents as a hard lump with a scaly surface, though it may also present as an ulcer.[1] Onset and development often occurs over several months.[4]

Compared to basal cell carcinoma, cSCC is more likely to spread to distant areas.[11] When confined to the epidermis, the outermost layer of the skin, the pre-invasive or in situ form of cSCC is termed Bowen's disease.[12][13]

The most significant risk factor for cSCC is extensive lifetime exposure to ultraviolet radiation from sunlight.[2] Additional risk factors include prior scars, chronic wounds, actinic keratosis, lighter skin susceptible to sunburn, Bowen's disease, exposure to arsenic, radiation therapy, tobacco smoking, poor immune system function, previous basal cell carcinoma, and HPV infection.[2][14][15] The risk associated with UV radiation correlates with cumulative exposure rather than early-life exposure.[16] Tanning beds have emerged as a significant source of UV radiation.

Genetic predispositions, such as xeroderma pigmentosum[17] and certain forms of epidermolysis bullosa,[18] also increase susceptibility to cSCC. The condition originates from squamous cells located in the skin's upper layers.[19] Diagnosis typically relies on skin examination, and is confirmed through skin biopsy.[2][3]

Research, both in vivo and in vitro, indicates a crucial role for the upregulation of FGFR2, part of the fibroblast growth factor receptor immunoglobin family, in cSCC cell progression.[20] Mutations in the TPL2 gene leads to overexpression of FGFR2, which activates the mTORC1 and AKT pathways in primary and metastatic cSCC cell lines. Utilization of a "pan FGFR inhibitor" has shown to reduce cell migration and proliferation in cSCC in vitro studies.[20]

Preventive measures against cSCC include minimizing exposure to ultraviolet radiation and the use of sunscreen.[5][6] Surgical removal is the typical treatment method,[2] employing simple excision for minor cases or Mohs surgery for more extensive instances.[2] Other options include cryotherapy and radiation therapy.[7] For cases with distant metastasis, chemotherapy or biologic therapy may be employed.[7]

As of 2015, approximately 2.2 million individuals globally were living with cSCC at any given time,[8] constituting about 20% of all skin cancer cases.[21] In the United States, approximately 12% of males and 7% of females are diagnosed with cSCC at some point in their lives.[2] While prognosis remains favorable in the absence of metastasis, upon distant spread the five-year survival rate is markedly reduced to ~34%.[4][5] In 2015, global deaths attributed to cSCC numbered around 52,000.[9] The average age at diagnosis is approximately 66 years.[4] Following successful treatment of an initial cSCC lesion, there is a substantial risk of developing subsequent lesions.[2]

  1. ^ a b Dunphy LM (2011). Primary Care: The Art and Science of Advanced Practice Nursing. F.A. Davis. p. 242. ISBN 9780803626478. Archived from the original on 2016-05-20.
  2. ^ a b c d e f g h i j Gandhi SA, Kampp J (November 2015). "Skin Cancer Epidemiology, Detection, and Management". The Medical Clinics of North America. 99 (6): 1323–1335. doi:10.1016/j.mcna.2015.06.002. PMID 26476255.
  3. ^ a b "Skin Cancer Treatment". National Cancer Institute. 21 June 2017. Archived from the original on 4 July 2017. Retrieved 2 July 2017.
  4. ^ a b c d Ferri FF (2016). Ferri's Clinical Advisor 2017 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1199. ISBN 9780323448383. Archived from the original on 29 August 2017. Retrieved 2 July 2017.
  5. ^ a b c d World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.14. ISBN 978-9283204299.
  6. ^ a b Jou PC, Feldman RJ, Tomecki KJ (June 2012). "UV protection and sunscreens: what to tell patients". Cleveland Clinic Journal of Medicine. 79 (6): 427–436. doi:10.3949/ccjm.79a.11110. PMID 22660875.
  7. ^ a b c "Skin Cancer Treatment". National Cancer Institute. 21 June 2017. Archived from the original on 4 July 2017. Retrieved 2 July 2017.
  8. ^ a b Vos, Theo; et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  9. ^ a b Wang, Haidong; et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  10. ^ "Skin Cancer Treatment (PDQ®)". NCI. 2013-10-25. Archived from the original on 5 July 2014. Retrieved 30 June 2014.
  11. ^ Cakir BÖ, Adamson P, Cingi C (November 2012). "Epidemiology and economic burden of nonmelanoma skin cancer". Facial Plastic Surgery Clinics of North America. 20 (4): 419–422. doi:10.1016/j.fsc.2012.07.004. PMID 23084294.
  12. ^ Yanofsky VR, Mercer SE, Phelps RG (2011). "Histopathological variants of cutaneous squamous cell carcinoma: a review". Journal of Skin Cancer. 2011: 210813. doi:10.1155/2011/210813. PMC 3018652. PMID 21234325. This article incorporates text available under the CC BY-SA 3.0 license.
  13. ^ Bath-Hextall FJ, Matin RN, Wilkinson D, Leonardi-Bee J (June 2013). "Interventions for cutaneous Bowen's disease". The Cochrane Database of Systematic Reviews. 2016 (6): CD007281. doi:10.1002/14651858.CD007281.pub2. PMC 6464151. PMID 23794286.
  14. ^ "Basal and Squamous Cell Skin Cancer Risk Factors". American Cancer Society.
  15. ^ Opel S, Ghali S (2016). "Skin Cancer for the Plastic Surgeon". Textbook of Plastic and Reconstructive Surgery (1 ed.). UCL Press. pp. 61–76. doi:10.2307/j.ctt1g69xq0.9. ISBN 978-1-910634-39-4. JSTOR j.ctt1g69xq0.9.
  16. ^ Gallagher RP, Lee TK, Bajdik CD, Borugian M (2010). "Ultraviolet radiation". Chronic Diseases in Canada. 29 (Suppl 1): 51–68. doi:10.24095/hpcdp.29.S1.04. PMID 21199599.
  17. ^ Lehmann AR, McGibbon D, Stefanini M (November 2011). "Xeroderma pigmentosum". Orphanet Journal of Rare Diseases. 6 (1): 70. doi:10.1186/1750-1172-6-70. PMC 3221642. PMID 22044607.
  18. ^ Bardhan A, Bruckner-Tuderman L, Chapple IL, Fine JD, Harper N, Has C, et al. (September 2020). "Epidermolysis bullosa". Nature Reviews. Disease Primers. 6 (1): 78. doi:10.1038/s41572-020-0210-0. PMID 32973163. S2CID 221861310.
  19. ^ "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Archived from the original on 9 November 2016. Retrieved 9 November 2016.
  20. ^ a b Khandelwal AR, Kent B, Hillary S, Alam MM, Ma X, Gu X, et al. (October 2019). "Fibroblast growth factor receptor promotes progression of cutaneous squamous cell carcinoma". Molecular Carcinogenesis. 58 (10): 1715–1725. doi:10.1002/mc.23012. PMC 6721978. PMID 31254372.
  21. ^ Stratigos A, Garbe C, Lebbe C, Malvehy J, del Marmol V, Pehamberger H, et al. (September 2015). "Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline". European Journal of Cancer. 51 (14): 1989–2007. doi:10.1016/j.ejca.2015.06.110. PMID 26219687.