Squamous cell carcinoma
Squamous cell carcinoma: Excerpt from Professional Guide to Diseases (Eighth Edition)
Squamous cell carcinoma of the skin is an invasive tumor with metastatic potential that arises from the keratinizing epidermal cells. Any change in an existing skin lesion, such as a wart or mole, or the development of a new lesion that ulcerates and doesn't heal may indicate skin cancer. If caught and treated early, there's a high cure rate. However, if squamous cell carcinoma is allowed to spread, it can result in disability or death.
Causes and incidence
Predisposing factors associated with squamous cell carcinoma include overexposure to the sun's ultraviolet rays, the presence of premalignant lesions (such as actinic keratosis or Bowen's disease), X-ray therapy, ingestion of herbicides containing arsenic, chronic skin irritation and inflammation, exposure to local carcinogens (such as tar and oil), and hereditary diseases (such as xeroderma pigmentosum and albinism). (See Premalignant skin lesions.) Rarely, squamous cell carcinoma may develop on the site of smallpox vaccination, psoriasis, or chronic discoid lupus erythematosus.
Squamous cell carcinoma usually occurs in fair-skinned white males older than age 60. Outdoor employment and residence in a sunny, warm climate (southwestern United States and Australia, for example) greatly increase the risk of developing squamous cell carcinoma.
Signs and symptoms
Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Lesions on sun-damaged skin tend to be less invasive and less likely to metastasize than lesions on unexposed skin. Notable exceptions to this tendency are squamous cell lesions on the lower lip and the ears. These are almost invariably markedly invasive metastatic lesions with a generally poor prognosis.
Transformation from a premalignant lesion to squamous cell carcinoma may begin with induration and inflammation of the preexisting lesion. When squamous cell carcinoma arises from normal skin, the nodule grows slowly on a firm, indurated base. If untreated, this nodule eventually ulcerates and invades underlying tissues. (See Staging squamous cell carcinoma, page 132.) Metastasis can occur to the regional lymph nodes, producing characteristic systemic symptoms of pain, malaise, fatigue, weakness, and anorexia.
Diagnosis
An excisional biopsy provides definitive diagnosis of squamous cell carcinoma. Other appropriate laboratory tests depend on systemic symptoms.
Treatment
The size, shape, location, and invasiveness of a squamous cell tumor and the condition of the underlying tissue determine the treatment method used; a deeply invasive tumor may require a combination of techniques. All the major treatment methods have excellent cure rates; generally, the prognosis is better with a well-differentiated lesion than with a poorly differentiated one in an unusual location. Depending on the lesion, treatment may consist of:
❑wide surgical excision
❑electrodesiccation and curettage (offer good cosmetic results for small lesions)
❑radiation therapy (generally for older or debilitated patients)
❑chemosurgery (reserved for resistant or recurrent lesions).
Special considerations
The care plan for patients with squamous cell carcinoma should emphasize meticulous wound care, emotional support, and thorough patient instruction.
❑Coordinate a consistent care plan for changing the patient's dressings. Establishing a standard routine helps the patient and family learn how to care for the wound.
❑Keep the wound dry and clean.
❑Try to control odor with balsam of Peru, yogurt flakes, oil of cloves, or other odor-masking substances, even though they're typically ineffective for long-term use. Topical or systemic antibiotics also temporarily control odor and eventually alter the lesion's bacterial flora.
❑Be prepared for other problems that accompany a metastatic disease (pain, fatigue, weakness, anorexia).
❑Help the patient and his family set realistic goals and expectations.
❑Disfiguring lesions are distressing to the patient and you. Try to accept the patient as he is and to increase his self-esteem and strengthen a caring relationship.
To prevent basal and squamous cell carcinoma, tell patients to:
❑avoid excessive sun exposure
❑wear protective clothing (hats, long sleeves)
❑periodically examine the skin for precancerous lesions; have any removed promptly
❑use strong sunscreening agents containing para-aminobenzoic acid, benzophenone, and zinc oxide. Apply these agents 30 to 60 minutes before sun exposure
❑use lip screens to protect the lips from sun damage.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Bowen's disease
More Medical Textbooks Online about Bowen's disease
Review other book chapters online related to Bowen's disease:
Medical Books Excerpts
- Skin, scaly
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Skin, scaly
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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