Molly Weinberg, MD1
Mariam Alam, MD3
Mollie Oudenhoven, MD1
Expert Review – Gil Weintraub, MD2
1 Clinical instructor, Department of Pediatrics and Chief Resident in Dermatology, University of Colorado.
2 Clinical Instructor, Department of Medicine, University of Colorado.
3 Clinical Instructor, Department of Medicine and Resident in Dermatology, University of Washington.
4 Assistant Professor, Department of Dermatology, University of Colorado
- Identify cutaneous squamous cell carcinoma based on exam.
- Determine the next best step in management for suspected cutaneous squamous cell carcinoma.
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.
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.
Take Home Points
- Squamous cell carcinoma of the skin can appear as papules, plaques, or nodules that can be smooth, hyperkeratotic, or ulcerated on sun-exposed areas, though they can also appear on non-sun-exposed areas in areas of HPV, radiation, etc.
- The best initial step in the management of a suspected squamous cell carcinoma is to perform a shave biopsy in order to evaluate for invasive disease and guide treatment.
Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology. 2018;78(2):237-247.