Skin+-+Squamous+Cell

In 1994, the annual incidence of squamous cell carcinoma in the United States ranged from 81-136 cases per 100,000 population for men and 26-59 cases per 100,000 population for women. 2 || -age older than 50 years -male sex -light skin; blonde or light brown hair; green, blue or gray eyes -geography (closer to the equator) -history of prior nonmelanoma skin cancer -exposure to UV light (high cumulative dose of sunshine, tanning beds or medical UV treatments -exposure to chemical carcinogents (e.g. arsenic, tar) -exposure to ionizing radiation (medical treatments, occupational or accidental radiation exposure) -chronic immunosuppression -chronic scarring conditions -certain genodermatoses -human papillomavirus (HPV) infection (specifc subtypes) 2 ||
 * Epidemiology: || Skin cancers account for nearly 1/3 of all cancers diagnosed in the United States each year. Approximately 800,000 new cases are diagnosed each year. 1
 * Etiology: || General risk factors associated with the development of squamous cell carcinoma are as follows:
 * Signs & Symptoms: || Most squamous cell carcinomas are discovered by patients and are brought to a physician's attention by the patient or a relative. The typical squamous cell carcinoma manifests as a new or enlarging lesion that concerns the patient. Squamous cell carcinoma is typically a slow-growing malignancy but some lesions enlarge rapidly. Although most squamous cell carcinoma patients are asymptomatic, symptoms such as bleeding, weeping, pain or tenderness may be noted especially with larger tumors. Numbness, tingling or muscle weakness may reflect underlying perineural involvement and this history finding is important to elicit because it adversely impacts prognosis.

Clinical presentation of squamous cell carcinoma (SCC) varies by type: -__Squamous cell carcinoma in situ__ - lesions range from a scaly pink patch to a thin keratotic papule or plaque. Bowen disease is a subtype characterized by a sharply demarcated pink plaque arising on non-sun exposed skin. Erythroplasia of Queyrat refers to Bowen disease of the glans penis which manifests as one or more velvety red plaques. -__Typical squamous cell carcinoma__ - the characteristic SCC is a raised, firm, pink to flesh colored keratotic papule or plaque arising on sun-exposed skin. Approximately 70% of all squamous cell carcinomas occur on the head and neck with an additional 15% found on the upper extremities. Surface changes may include scaling, ulceration, crusting or the presence of a cutaneous horn. -__Periungual squamous cell carcinoma__ - typically mimics a verruca and is frequently misdiagnosed for years as a wart prior to biopsy. Lesions may also resemble chronic paronychia with swelling, erythema and tenderness of the nail fold; onychodystrophy also may be noted. -__Marjolin ulcer__ - this subtype appears as a new area of induration, elevation or ulceration at the site of a preexisting scar or ulcer. -__Perioral squamous cell carcinoma__ - SCC of the lip usually arises on the vermillion border of the lower lip. It is sometimes predated by a precursor lesion, actinic cheilitis, which manifests as xerosis, fissuring, atrophy and dyspigmentation. SCC of the lip manifests as a new papule, erosion or focus of erythema/induration. -__Anogenital squamous cell carcinoma__ - SCC of the anogenital region may manifest as a moist, red plaque on the glans penis; indurated or ulcerated lesions may be seen on the vulva, external anus or scrotum. Associated symptoms include pain, pruritus and intermittent bleeding. -__Verruccous carcinoma__ - subtype of SCC; lesions appear as exophytic, fungation, verruccous nodules or plaques, which may be described as "cauliflowerlike". 2 || -Physical examination should focus on appreciation of changes in the normal appearance of the skin. -The size, diameter, depth of invasion and mulitfocality of the tumor must be precisely defined. -Regional lymph nodes must be assessed. -Various tools to assess the skin, including Wood's light and potassium hydroxide preparations, fungal cultures, skin biopsies, Tzanck smears and patch testing should be used. 1 || Grading for Squamous Cell. 4 || Staging for Carcinoma of the Skin. 5 || 40 Gy to 45 Gy in 2.5 to 3 Gy fractionons. 1 2cm to 1cm boarders. ||
 * Diagnostic Procedures: || -The diagnosis of skin cancer requires a detailed clinical history.
 * Histology: || Squamous cell carcinoma in situ, Typical squamous cell carcinoma, Periungual squamous cell carcinoma, Marjolin ulcer, Perioral squamous cell carcinoma, Anogenital squamous cell carcinoma, Verruccous carcinoma 2 ||
 * Lymph Node Drainage: || Location of drainage via the lymphatics varies depending on the site of initial findings. ||
 * Metastatic Spread: || The overall risk of metastatic spread for squamous cell carcinoma skin cancers is 2-6%. However, rates have been as high as 47% for cases with extensive perineural invasion. 2 ||
 * Grading: || [[image:grading1.jpg width="145" height="88"]]
 * Staging: || [[image:carcinomaofskin1.jpg width="204" height="293"]]
 * Radiation Side Effects: || Side effects may include erythema, skin irritation, dry desquamation and moist desquamation. 2 ||
 * Prognosis: || Studies have shown 5-year survival rates as high as 73% achieved with the combination of surgery and radiation therapy. Once lung metastasis occurs, the disease is currently incurable. 2 ||
 * Treatments: || Surgery to remove area and Radiation Therapy.
 * TD5/5: || The TD5/5 of skin is 15-20Gy for single dose and 30-40Gy for fractionated dose. 1 ||
 * Planning Photos || <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">Field set-up photo of a squamous cell carcinoma on the cheek treated with electrons. <span style="color: #008000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">3

Squamous Cell field photo on the neck. 6

Squamous Cell planning photo on the neck. 7 || <span style="font-family: Arial,Helvetica,sans-serif;">**References** 1. Chao KS, Perez CA, Brady LW. //<span style="font-family: Arial,Helvetica,sans-serif;">Radiation Oncology - Management Decisions. // <span style="font-family: Arial,Helvetica,sans-serif;"> 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 2002: 111-122. 2. eMedicine. Squamous Cell Carcinoma. []. Accessed February 11, 2010. 3. Field set-up photos courtesy of Bridget Keehan, RT(T), The Cancer Team at Bellin Health. 4. Gunderson and Tepper. Clinical Radiation Oncology. 2nd Edition. Philadelphia, PA: Churchill Livingstone. 2007. 5. Cox. Radiation Oncology; //Rationale, Technique, Results//. 8th Edition. St. Louis, MO: Mosby. 2003. 6. Mendenhall W., et al. Stage T3 Squamous Cell Carcinoma of the Glottic Larynx treated with Surgery and/or Radiation Therapy. //Int. J. Radiation Oncol.// 1984; 10(3): 357-363. 7. Hodge C., et al. Are We Influencing Outcome in Oropharynx Cancer with Intensity Modulated Radiotherapy? An Inter-Era Comparison. //Int. J. Radiation Oncol.// 2007; 69(4): 1032-1041.