0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43
Nonmelanoma Skin Cancers: BCC Nonmelanoma Skin Cancers: SCC 1063■Patients with BCC prior to age 60 may have a higher rate of breast
cancer, testicular cancer and non-Hodgkin’s lymphoma.
complications and prognosis
■Deep invasion and local destruction (eye, ear, nose, even into the
brain are the greatest risk)
■Recurrence varies with treatment; lowest with MMS
■Metastasis is extremely rare (0.0028%) since there is a need for sup-
porting stromal tissue for cell survival. Usually in the head or neck
with extremely large or multiply recurrent lesions.
■Very likely to develop other primary skin cancers, especially if pos-
itive family history, extensive sun exposure, history with multiple
AKs, or immunosuppressed.NONMELANOMA SKIN CANCERS:
SQUAMOUS CELL CARCINOMA
ROGER I. CEILLEY, MD
history & physical
■Often begins as a reddish, indurated nodule with a hard keratotic or
ulcerated surface on ears, face, lips, dorsum of hands and arms
■May begin as small keratotic papule or scaly plaque
■Usually in individuals with fair skin, eyes and hair, and individuals
(>60%) with actinic damage and actinic keratoses. Head and neck
most common, 90% on sun-exposed areas.
■Incidence increases with age; most are >40 years old
■May develop in old scars, x-ray-damaged skin, chronic ulcers and
chronic HPV infections (esp. in types 16, 18, 31 and 33)
■May grow in a few months, become large, ulcerated and deeply inva-
sive
■Metastasis may be early if lesion large and ulcerated, patient is
immunosuppressed or with tumors arising in chronic ulcers
■Lower lip lesions often develop in actinic cheilitis.
■Palpate regional nodules.tests
■Biopsy
■Chest x-ray, CT scan, needle aspirate or node biopsy if metastasis
suspected