Squamous cell carcinoma (SCC)

Squamous cell carcinoma is the second most common malignancy of the skin after basal cell carcinoma. More than 100,000 new cases are found throughout the world. Estimated incidence of 20% - 25% of basal cell carcinoma and constitute 25% of all malignancies in the skin. This malignancy is often found in the white population is very rare in the black community and the general strike middle age (always above the age of 40 years). Men are more often affected than the women with 900 incidents versus 300 per 100,000, respectively - helped. The incidence of squamous cell carcinoma continues to increase, it is likely caused by exposure to ultraviolet radiation. The black population that has generally occurred on predisposing factors such as burns, scars or trauma.

Squamous cell carcinoma is a neoplasm of keratin cells that show the character of malignancies including anaplasia, rapid growth, local invasion and metastasis potential. Incidence of metastases overall 2% - 3%. Cancerous lesions are generally located on the face, arms, back and dorsum manus. Squamous cell carcinoma often invades the subcutaneous tissue and the pain indicates a perineural extension.

1. Clinical Overview

Presence of risk factors, history of solar burn, history of organ transplantation, the consumption of drugs imunosuipresif, HIV and so on. History tumor growth of healthy skin (de novo), or of pre-existing lesions. It should be noted the possibility of multiple lesions, particularly in patients with white skin. Family history, or have ever suffered from skin cancer earlier, is also a risk factor.

Physical examination is primarily aimed at the area of ​​the primary tumor and regional lymph nodes of its base.

On physical examination to note the shape / morphology of the primary tumor, fungating formations such as "cauliflower (cauliflower)", ulceration, presence or absence of crusting, depth of infiltration, odors because of the presence of tissue necrosis or secondary infection. The depth of infiltration is important to know the possibility of involvement of other structures (bones, cartilage), and metastasis potential.

Palpation carefully whether there is enlargement of the regional KGB KGB, and examination of the possibility of such keparu distant metastases, liver and so on.

2. Classification Histo-Pathology

Good biopsy is important to distinguish SCC in situ and invasive SCC. At umumna SCC indicated by "a collection of epidermal cells" that invade the dermis / subdermis, with atypical squamous cell shape and the presence of mitosis. Differentiation of SCC indicated by the degree of atypia of the cells of the epidermis.

Bowen's disease is a SCC in situ.

Spindle cell SCC.

A rare variance from SCC that have a more aggressive nature, poorly differentiated, invasion of deeper tissue structures mempunuyai greater metastatic potential and poor prognosis. To diagnose spindle cell SCC examination required by immunohistochemical staining.

Acantholytic / adenoid SCC

Is a rare variant, often found the head neck area, and form a collection of cells dyskeratosis and acantholisis in the central part, and often form a structure pseudoglandular.

Histological grading:

Grading Gx can not be checked

Differentiation G1 good

G2 differentiation medium

G3 bad Differentiation

G4 undifferentiated

-                      3. Therapeutic Procedures

SCC therapy is not much different from the BCC. Action depending on anatomic location, big, depth of invasion / infiltration, histological grading, presence or absence of regional lymph nodes are enlarged / exposed, history of treatment / surgery previously, distant metastases and the ability of the surgeon.

The main treatment modality is surgery that wide excision with adequate surgical margin of safety (1 cm or>). Surgical defect can be closed by sewing primary, skin grafting (partial or full thickness depending on location anatomy), rotation flap, transposition flap, advancement flap, interpolation flap. To a large defect can be performed reconstruction with free vascularized distant flap or graft.

For lesions difficult areas such as the canthus, nasolabial, per-orbital, periauricular, it is recommended to do Mohs Micrographic Surgery, and if not possible wide excision and reconstruction.

SCC with infiltration / invasion of surrounding tissue (bone, cartilage, etc.) can be done compound excision and reconstruction, and or administration of radiotherapy (if margin of + or "narrow").

For lesions in the penis do partial or total penectomy and inguinal sentinel node biopsy (KGB at fossa ovalis femur) and if the KGB +, ingunal superficial dissection. SCC anus, can be done on a wide excision and large SCC / inoperable may be given chemotherapy (based Cisplatinum) or radiotherapy or given concomittant.

Metastatic regional lymph nodes, lymph nodes dissection, the type and surgical technique depends on the anatomical location of the KGB. Metastasis KGB encouraged to perform selective neck lymph nodes dissection (SLND) or functioning radical neck dissection. Axillary nodes do axillary lymph nodes dissection to level II and III.

Inguinal lymph nodes metastasis done superficial inguinal lymph nodes dissection.