Squamous cell carcinoma of the skin (spinocellular carcinoma, SCC)

Squamous cell carcinoma, spinalioma, epithelioma spinocellulare, carcinoma spinocellulare, keratinising squamous cell carcinoma of the skin, prickle cell carcinoma, spindle cell carcinoma, keratinising squamous cell carcinoma, squamous cell carcinoma.

Epithelial carcinoma, which can metastasise in rare cases.

• Second most common malignant skin tumour (Caucasian)
• Incidence: 30/100,000/year (North-South gradient)
• Average age: 70 years
• Men:women = 2:1
• Spinocellular carcinoma accounts for approximately 20% of all non-melanoma skin cancer
• In recent decades, there has been a sharp increase in incidence

• Histological classification:
  • Carcinoma in situ of the skin (KIN III)
  • Carcinoma in situ of the mucosa in penile, anal and vaginal carcinoma (PIN, AIN, VIN III)
  • Spinocellular carcinoma (classic type)
  • Acantholytic squamous cell carcinoma
  • Mucinsecreting squamous cell carcinoma
  • Desmoplastic squamous cell carcinoma
  • Small cell squamous cell carcinoma
  • Clear cell squamous cell carcinoma
  • Lymphoepithelioma-like carcinoma of the skin

• In situ carcinomas (actinic keratoses, Bowen's disease, erythroplasia queyrate, actinic cheilitis) are the precursors of SCC. However, squamous cell carcinomas can also form de novo. The aetiopathogenesis is multifactorial.

• Causative or predisposing factors may be:
  • Actinic keratoses
  • Positive family history
  • Light skin type
  • Sun exposure (incl. solarium)
  • Ionising radiation
  • High-risk human papillomavirus
  • Older age
  • Chronic heat exposure (erythema ab igne) or burns
  • Chronic degenerative and chronic inflammatory skin lesions
  • Albinism
  • Xeroderma pigmentosum
  • Muir-Torre syndrome
  • Epidermolysis bullosa hereditaria
  • Scars (also lupus vulgaris scars)
  • Atrophic lupus erythematosus foci
  • Acrodermatitis chronica atrophicans
  • Lower leg ulcers Marjolin's ulcer (about 1:5000)
  • Acne inversa
  • Lichen ruber erosivus mucosae
  • Glossitis interstitialis syphilitica
  • Lichen sclerosus et atrophicus of the vulva or penis
  • Workers in petroleum refineries
  • Coal tar industry
  • Road construction with tar
  • Soot (chimney sweep cancer)
  • Arsenic
  • Immune suppression (approx. 200-fold increased risk)
  • Alcohol abuse, especially with high-proof spirits
  • Smoking (tar distillates)

• Leukoplakic, coarse, painless, usually exophytic, often hyperkeratotic, but sometimes eroded plaques or nodules
• When there is severe, horn-like hyperkeratosis, one can speak of a cornu cutaneum
• Verrucous carcinoma (Ackermann carcinoma) shows a wart-like surface plantar
• Metastasis is both lymphogenic and later haematogenic

• Anamnesis regarding predisposing factors
• Clinic
• Biopsy
• If the diagnosis is confirmed by dermatopathology, a full body inspection should be performed
• Examination of the locoregional lymph nodes
• According to localisation and other attributes, follow current SOP for staging examinations and follow-up

• 90% of all SCC are located in the head area
• Rarely: oral mucosa, genital, toes, fingers

• From the surface of the skin or mucosa, there is infiltration of finger-shaped, branching tumour cords that destroy the basement membrane and grow into the depths
• The cells originate from the str. spinosum (ergo: spinocellular carcinoma). A keratinising squamous epithelium with horny beads (squamous eddies) is formed. Nuclear polymorphism, atypical mitoses, nuclear hyperchromasia, polyploidy, dyskeratosis, hyperkeratosis, cell atypia, mitoses, inflammatory infiltrate

• Immunohistochemical differentiation from basal cell carcinoma is by Ber-EP4 marker
• Immunohistochemical differentiation from adnexal tumours is done by cytokeratin marker CAM-5.2

WHO classification listed as follows:

• Spindle cell squamous cell carcinoma of the skin (aggressive behaviour)
• Acantholytic (pseudoglandular) squamous cell carcinoma of the skin
• Verrucous squamous cell carcinoma of the skin (prognostically favourable)
• Squamous cell carcinoma with horn formation
• Lymphoepithelioma-like squamous cell carcinoma of the skin

• Grade of differentiation according to Broders is dependent with the number of atypical undifferentiated cells
• Grade I <25%, Grade II <50%, Grade III <75%, Grade IV >75%
• The higher the grade, the higher the metastatic tendency

For more information on staging, see SOP SCC (in progress).

• Metastasis: ≤ 2 mm (0%), 2-6 mm (4%), > 6 mm (16%)
• With metastasis, the median survival time is 2 years
• Penile, vulvar and auricular carcinomas tend to metastasise early

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