Cutaneous Squamous Cell Carcinoma (cSCC)

Plan to spend 5-10 minutes practicing the flow of the presentation and reviewing the images of squamous cell carcinoma provided.

Present the images by expanding the window or downloading the PowerPoint file. Ask the learners to provide a description of the lesions they are viewing. Ask about what is characteristic of these lesions (papules, plaques, nodules that can be smooth, hyperkeratotic, or ulcerated1).  Ask what the learners think is the most likely diagnosis.

Instructions:
1.Ask a learner to provide a description of the skin lesion seen.
2.Then ask a learner to provide their diagnosis of the lesion.
3.Ask what the next best step would be to confirm the diagnosis.

Dermatology description: Well-defined erythematous dome-shaped nodule with central crust.

Diagnosis: Cutaneous Squamous cell carcinoma

Next best step: Perform a shave biopsy with 2mm margins.

Teaching: The first objective is to diagnose a squamous cell carcinoma of the skin by imaging. The primary risk factor is ultraviolet radiation exposure. They can occur on any surface of the skin however sun-exposed areas are most common in lighter-skinned persons. In darker-skinned individuals, non-sun exposed areas, such as the lower legs and anogenital region, are most common. The next best step in diagnosis is performing a shave biopsy ensuring that it extends into the mid-reticular dermis to evaluate for invasive disease. Treatment options include surgical excision (including Mohs surgery for cosmetic areas), electrodessication and curettage, cryotherapy, photodynamic therapy, radiation therapy for non-surgical candidates, and topical therapies such as Fluorouracil or Imiquimod.