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Squamous cell carcinoma dermoscopy

Author: Naomi Ashman, Dermoscopist, Torbay Skin, Auckland, New Zealand; DermNet New Zealand Editor in Chief, Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. Created 2019.


What is cutaneous squamous cell carcinoma?

Cutaneous squamous cell carcinoma is a common type of keratinocytic or nonmelanoma skin cancer. It is commonly found on sun-exposed areas of skin. It can be invasive and metastasise. It is also known as cutaneous squamous cell carcinoma, and commonly abbreviated to SCC.

What are the clinical features of squamous cell carcinoma?

Cutaneous squamous cell carcinoma presents clinically as an enlarging, irregular, keratinous nodule or a firm erythematous plaque that frequently ulcerates.

They usually arise within pre-existing actinic keratosis or intraepidermal carcinoma.

  • They grow over weeks to months
  • They may ulcerate
  • They are often tender or painful
  • Located on sun-exposed sites, particularly the face, lips, ears, hands, forearms, and lower legs
  • Size varies from a few millimetres to several centimetres in diameter
  • They are rarely pigmented.

What are the dermoscopic features of squamous cell carcinoma?

The common dermoscopic features of cutaneous squamous cell carcinoma are:

  • White circles
  • White structureless areas
  • Looped vessels
  • Central keratin
  • Pink or red background in poorly differentiated or rapidly growing tumours.

Pigmented cutaneous squamous cell carcinoma has brown, blue or grey areas.

What is the dermoscopic differential diagnosis of squamous cell carcinoma?

The dermoscopic differential diagnosis of cutaneous squamous cell carcinoma includes its variants:

Other conditions to consider include:

What is the histological explanation for squamous cell carcinoma?

Histologically, there is a proliferation of atypical keratinocytes within the dermis.

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References

  • Motley R, Kersey P, Lawrence C; British Association of Dermatologists; British Association of Plastic Surgeons; Royal College of Radiologists, Faculty of Clinical Oncology. Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Dermatol. 2002;146(1):18-25. doi:10.1046/j.0007-0963.2001.04615.x. PubMed
  • Parikh SA, Patel VA, Ratner D. Advances in the management of cutaneous squamous cell carcinoma. F1000Prime Reports. 2014;6:70. DOI: 10.12703/P6-70. PubMed Central
  • Guidelines of care for the management of cutaneous squamous cell carcinoma. Alam, MuradKim, John YS, et al. J Am Acad Derm. DOI: doi.org/10.1016/j.jaad.2017.10.007. Journal

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