External Medicine
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Squamous Cell Carcinoma
OVERVIEW
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Traditionally considered to be less frequent than BCC, but may approach 1:1 ratio in some settings.
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Most common skin Ca in Hispanic, Black, and Asian phenotypes.
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In central and southern US, mortality rates from SCC approximates that of renal and oropharyngeal Caa.
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Because of its prevalence, mortalities per year approach those of melanoma (controversial topic - many claim SCC deaths are greater than melanoma deaths, and many claim the opposite).
INCIDENCE
Rate of Second Primary, Metastasis, Death after Initial Diagnosis 37466985
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In a Norwegian cancer registry cohort including organ transplant (OTR) and non-organ transplant recipients (non-OTR):
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Incidence: ~0.02% per year (very low)
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Rate of 2nd SCC: ~3% (non-OTR), ~25% (OTR) per year
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Rate of metastasis: 0.28% (non-OTR), 0.48% (OTR) per year
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Rate of death (from cSCC): 0.17% (non-OTR), 0.54% (OTR) per year
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Cumulative incidence is highest in first 1-2 years, and plateaus by about year 5:
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Second SCC: 16.2% (non-OTR), 55% (OTR) 5-year cumulative incidence
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Metastasis: 1.7% (non-OTR), 2.2% (OTR) 5-year cumulative incidence
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Death: 0.9% (non-OTR), 3.7% (OTR) 5-year cumulative incidence
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20 year cumulative incidence:
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Second SCC: 17.9% (non-OTR), 56.4% (OTR)
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Metastasis: 2.0% (non-OTR), 2.4% (OTR)
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Death: 1.4% (non-OTR), 4.5% (OTR)
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LITERATURE
Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol. 2018. PMID: 29332704.
EM OPINES: Nice overview of that which is mentioned in the title, which also has a comprehensive figure on risk factors borrowed from PMID: 26762219. FIGURE
ABSTRACT: Cutaneous squamous cell carcinoma (cSCC), a malignant proliferation of cutaneous epithelium, represents 20% to 50% of skin cancers. Although the majority of cSCCs are successfully eradicated by surgical excision, a subset of cSCC possesses features associated with a higher likelihood of recurrence, metastasis, and death. The proper identification of these aggressive cSCCs can guide additional work-up and management. In the first article in this continuing medical education series, we discuss the incidence, recurrence rates, mortality rates, and risk factors associated with cSCC and review the staging systems used to stratify patients into high- and low-risk groups. The second article in this series reviews the treatment options for cSCC, with focused attention on the management of high-stage tumors.