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Squamous Cell Carcinoma

Updated : April 18, 2024





Background

In the United States, squamous cell carcinoma of the skin, also known as cutaneous squamous cell carcinoma, is the second most prevalent form of skin cancer, behind basal cell carcinoma.

Actinic Keratosis appears as a precursor lesion before SCC development, and it demonstrates tumor growth, and has the ability to spread inside the body.

Ultraviolet (UV) sun radiation is the key risk factor for the development of cutaneous squamous cell carcinoma, and cumulative lifetime exposure plays a significant role in the progression of this malignancy.

Mohs micrographic surgery is the best method for treating cutaneous squamous cell carcinoma which presents on the neck, head, and other high-risk areas. SCCs which have particularly dangerous characteristics are also treated with MMS. Only patients who cannot sustain surgery are suggested radiotherapy. This is generally the case with the elderly.

Very high tumors are typically treated with adjuvant radiation following surgical intervention. Lifetime squamous cell carcinoma risk is considerably increased by immunosuppression.

Metastasis is uncommon in squamous cell carcinomas that arise in areas of persistent sun exposure, although it can occur, and the risk is elevated in immunocompromised people.

Individuals with cutaneous SCC should be evaluated routinely and reminded to use UV protection measures.

Epidemiology

Following Basal Cell Carcinoma, SCC is the skin cancer which most people in the US are afflicted with. Previously BCC would affect 3 times more individuals than Squamous Cell Carcinoma, but now the number of individuals affected are almost the same.

They’re both responsible for around 1 million cases each annually.

It has been observed that the ratio tends toward the occurrence of squamous cell carcinoma as age increases. White-skinned individuals with light eyes, and significant exposure to UV rays are extremely susceptible to SCC, especially after turning 50.

Those having a history of extensive UV exposure, whether because of a history of sun exposure or medical treatment, are at a higher risk.

Immunosuppressed patients also have a high incidence of squamous cell carcinoma, which can progress into aggressive subtypes.

Anatomy

Pathophysiology

UV exposure is recognized as the primary risk factor for cutaneous squamous cell cancer.

The most prevalent genetic anomalies in actinic keratosis, squamous cell carcinoma in situ, and invasive squamous cell carcinoma are mutations in the p53 gene.

Some of the common risk factors for Squamous Cell Carcinoma development are:

  • Tanning lamp use
  • Therapeutic exposure to UV rays
  • Ionizing radiation

This process most likely happens through the p53 pathway. The p53 protein prevents the replication of cells with mutant or damaged DNA.

If the p53 gene becomes altered in any of the aforementioned ways, the p53 protein becomes inactive, and cells with damaged DNA, such as those present in squamous cell carcinoma, are able to proliferate.

Etiology

The leading cause of SCC is solar UV radiation. Squamous cell carcinoma can also be caused by extended periods of exposure to substances which increase cancer risk, such as the tar in cigarettes.

Other probable reasons include a severe burn scar, a long-standing ulcer or sore, and some forms of HPV, particularly in the vaginal area.

Genetics

Researchers do not yet understand all of the DNA alterations that lead to Squamous Cell Carcinoma, or Basal Cell Carcinoma — nevertheless, they have discovered that in many skin malignancies, tumor suppressor genes are altered.

The TP53 tumor suppressor gene is most frequently mutated in squamous cell malignancies. Typically, this gene causes DNA-damaged cells to perish.

When the TP53 gene mutates, aberrant cells may survive for longer, and eventually develop into malignant cells.

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

cemiplimab

350 mg given IV over 30 minutes every three weeks
continue the drug until disease progression, or unacceptable toxicity occurs



Dose Adjustments

Renal impairment:
No adjustment is recommended.
Liver impairment:
No adjustment is recommended.

pembrolizumab

Monotherapy:

200

mg

Intravenous (IV)

every 3 weeks

OR 400 mg Intravenous (IV) every 6 weeks



cemiplimab

300

mg

Intravenous (IV)

over 30 minutes

3

weeks


continue the drug until disease progression, or unacceptable toxicity occurs



Dose Adjustments

Renal impairment:
No adjustment is recommended.
Liver impairment:
No adjustment is recommended.

bleomycin

0.25 - 0.5

unit/kg

Intravenous (IV)/IM/SC

1-2 times a week



 
 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK441939/

https://www.cancer.org/content/dam/CRC/PDF/Public/8819.00.pdf

Squamous Cell Carcinoma

Updated : April 18, 2024




In the United States, squamous cell carcinoma of the skin, also known as cutaneous squamous cell carcinoma, is the second most prevalent form of skin cancer, behind basal cell carcinoma.

Actinic Keratosis appears as a precursor lesion before SCC development, and it demonstrates tumor growth, and has the ability to spread inside the body.

Ultraviolet (UV) sun radiation is the key risk factor for the development of cutaneous squamous cell carcinoma, and cumulative lifetime exposure plays a significant role in the progression of this malignancy.

Mohs micrographic surgery is the best method for treating cutaneous squamous cell carcinoma which presents on the neck, head, and other high-risk areas. SCCs which have particularly dangerous characteristics are also treated with MMS. Only patients who cannot sustain surgery are suggested radiotherapy. This is generally the case with the elderly.

Very high tumors are typically treated with adjuvant radiation following surgical intervention. Lifetime squamous cell carcinoma risk is considerably increased by immunosuppression.

Metastasis is uncommon in squamous cell carcinomas that arise in areas of persistent sun exposure, although it can occur, and the risk is elevated in immunocompromised people.

Individuals with cutaneous SCC should be evaluated routinely and reminded to use UV protection measures.

Following Basal Cell Carcinoma, SCC is the skin cancer which most people in the US are afflicted with. Previously BCC would affect 3 times more individuals than Squamous Cell Carcinoma, but now the number of individuals affected are almost the same.

They’re both responsible for around 1 million cases each annually.

It has been observed that the ratio tends toward the occurrence of squamous cell carcinoma as age increases. White-skinned individuals with light eyes, and significant exposure to UV rays are extremely susceptible to SCC, especially after turning 50.

Those having a history of extensive UV exposure, whether because of a history of sun exposure or medical treatment, are at a higher risk.

Immunosuppressed patients also have a high incidence of squamous cell carcinoma, which can progress into aggressive subtypes.

UV exposure is recognized as the primary risk factor for cutaneous squamous cell cancer.

The most prevalent genetic anomalies in actinic keratosis, squamous cell carcinoma in situ, and invasive squamous cell carcinoma are mutations in the p53 gene.

Some of the common risk factors for Squamous Cell Carcinoma development are:

  • Tanning lamp use
  • Therapeutic exposure to UV rays
  • Ionizing radiation

This process most likely happens through the p53 pathway. The p53 protein prevents the replication of cells with mutant or damaged DNA.

If the p53 gene becomes altered in any of the aforementioned ways, the p53 protein becomes inactive, and cells with damaged DNA, such as those present in squamous cell carcinoma, are able to proliferate.

The leading cause of SCC is solar UV radiation. Squamous cell carcinoma can also be caused by extended periods of exposure to substances which increase cancer risk, such as the tar in cigarettes.

Other probable reasons include a severe burn scar, a long-standing ulcer or sore, and some forms of HPV, particularly in the vaginal area.

Researchers do not yet understand all of the DNA alterations that lead to Squamous Cell Carcinoma, or Basal Cell Carcinoma — nevertheless, they have discovered that in many skin malignancies, tumor suppressor genes are altered.

The TP53 tumor suppressor gene is most frequently mutated in squamous cell malignancies. Typically, this gene causes DNA-damaged cells to perish.

When the TP53 gene mutates, aberrant cells may survive for longer, and eventually develop into malignant cells.

cemiplimab

350 mg given IV over 30 minutes every three weeks
continue the drug until disease progression, or unacceptable toxicity occurs



Dose Adjustments

Renal impairment:
No adjustment is recommended.
Liver impairment:
No adjustment is recommended.

pembrolizumab

Monotherapy:

200

mg

Intravenous (IV)

every 3 weeks

OR 400 mg Intravenous (IV) every 6 weeks



cemiplimab

300

mg

Intravenous (IV)

over 30 minutes

3

weeks


continue the drug until disease progression, or unacceptable toxicity occurs



Dose Adjustments

Renal impairment:
No adjustment is recommended.
Liver impairment:
No adjustment is recommended.

bleomycin

0.25 - 0.5

unit/kg

Intravenous (IV)/IM/SC

1-2 times a week



https://www.ncbi.nlm.nih.gov/books/NBK441939/

https://www.cancer.org/content/dam/CRC/PDF/Public/8819.00.pdf