Squamous Cell Carcinoma: An Update on Diagnosis and Treatment
Keywords:
Bowen disease, squamous cell carcinoma, actinic keratosis, cancerization field, dermoscopy, confocal microscopy, staging, treatmentAbstract
Squamous cell carcinoma (SCC) accounts for most nonmelanoma skin cancer–related metastatic disease and deaths. Histopathology and correct surgical excision remain the gold standard for the diagnosis and treatment of SCC; however, new diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy have increased the diagnostic accuracy in terms of early recognition, better differential diagnosis, more precise selection of areas to biopsy, and noninvasive monitoring of treatments. The therapeutic intervention in patients with severe actinic damage and multiple in situ/low-risk SCC, and the development of innovative treatments such as epidermal growth factor receptor inhibitors and immune checkpoint inhibitors for locally advanced and metastatic SCC, are improving considerably the approach to the disease. This review summarizes the up-to-date knowledge in the field of detection, treatment, and monitoring of cutaneous SCC.
References
Warszawik-Hendzel O, Olszewska M, Maj M, Rakowska A, Czuwara J, Rudnicka L. Non-invasive diagnostic techniques in the diagnosis of squamous cell carcinoma. J Dermatol Case Rep. 2015;9(4):89-97. https://doi.org/10.3315/jdcr.2015.1221
Alam M, Armstrong A, Baum C, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-578. https://doi.org/10.1016/j.jaad.2017.10.007
Kim C, Cheng J, Colegio OR. Cutaneous squamous cell carcinomas in solid organ transplant recipients: emerging strategies for surveillance, staging, and treatment. Semin Oncol. 2016;43(3):390-394. https://doi.org/10.1053/j.seminoncol.2016.02.019
Ulrich M, Stockfleth E, Roewert-Huber J, Astner S. Noninvasive diagnostic tools for nonmelanoma skin cancer. Br J Dermatol. 2007;157 Suppl 2:56-58. https://doi.org/10.1111/j.1365-2133.2007.08275.x
Zalaudek I, Giacomel J, Argenziano G, et al. Dermoscopy of facial nonpigmented actinic keratosis. Br J Dermatol. 2006;155(5):951-956. https://doi.org/10.1111/j.1365-2133.2006.07426.x
Zalaudek I, Giacomel J, Schmid K, et al. Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: a progression model. J Am Acad Dermatol. 2012;66(4):589-597. https://doi.org/10.1016/j.jaad.2011.02.011
Pan Y, Chamberlain AJ, Bailey M, Chong AH, Haskett M, Kelly JW. Dermatoscopy aids in the diagnosis of the solitary red scaly patch or plaque-features distinguishing superficial basal cell carcinoma, intraepidermal carcinoma, and psoriasis. J Am Acad Dermatol. 2008;59(2):268-274. https://doi.org/10.1016/j.jaad.2008.05.013
Carrera C, Puig S, Malvehy J. In vivo confocal reflectance microscopy in melanoma. Dermatol Ther. 2012;25(5):410-422. https://doi.org/10.1111/j.1529-8019.2012.01495.x
Pellacani G, Scope A, Ferrari B, et al. New insights into nevogenesis: in vivo characterization and follow-up of melanocytic nevi by reflectance confocal microscopy. J Am Acad Dermatol. 2009;61(6):1001-1013. https://doi.org/10.1016/j.jaad.2009.04.018
Malvehy J, Hanke-Martinez M, Costa J, Salerni G, Carrera C, Puig S. Semiology and pattern analysis in nonmelanocytic lesions. In: Hofmann-Wellenhof R, Pellacani G, Malvehy J, Soyer HP, eds. Reflectance Confocal Microscopy for Skin Diseases. Berlin, Heidelberg: Springer-Verlag; 2012:237-252. https://doi.org/10.1007/978-3-642-21997-9_18
Pellacani G, Ulrich M, Casari A, et al. Grading keratinocyte atypia in actinic keratosis: a correlation of reflectance confocal microscopy and histopathology. J Eur Acad Dermatol Venereol. 2015;29(11):2216-2221. https://doi.org/10.1111/jdv.13215
Seyed Jafari SM, Timchik T, Hunger RE. In vivo confocal microscopy efficacy assessment of daylight photodynamic therapy in actinic keratosis patients. Br J Dermatol. 2016;175(2):375-381. https://doi.org/10.1111/bjd.14517
Moscarella E, Rabinovitz H, Zalaudek I, et al. Dermoscopy and reflectance confocal microscopy of pigmented actinic keratoses: a morphological study. J Eur Acad Dermatol Venereol. 2015;29(2):307-314. https://doi.org/10.1111/jdv.1253
Peppelman M, Nguyen KP, Hoogedoorn L, van Erp PE, Gerritsen MJ. Reflectance confocal microscopy: non-invasive distinction between actinic keratosis and squamous cell carcinoma. J Eur Acad Dermatol Venereol. 2015;29(7):1302-1309. https://doi.org/10.1111/jdv.12806
Rishpon A, Kim N, Scope A, et al. Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses. Arch Dermatol. 2009;145(7):766-772. https://doi.org/10.1001/archdermatol.2009.134
Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62(2):247-256. https://doi.org/10.1016/j.jaad.2009.06.016
Marmur ES, Berkowitz EZ, Fuchs BS, Singer GK, Yoo JY. Use of high-frequency, high-resolution ultrasound before Mohs surgery. Dermatol Surg. 2010;36(6):841-847. https://doi.org/10.1111/j.1524-4725.2010.01558.x
Fujimoto JG, Pitris C, Boppart SA, Brezinski ME. Optical coherence tomography: an emerging technology for biomedical imaging and optical biopsy. Neoplasia. 2000;2(1-2):9-25.
Longo C, Ragazzi M, Rajadhyaksha M, et al. In vivo and ex vivo confocal microscopy for dermatologic and Mohs surgeons. Dermatol Clin. 2016;34(4):497-504. https://doi.org/10.1016/j.det.2016.05.012
Pérez-Anker J, Ribero S, Yélamos O, et al. Basal cell carcinoma characterization using fusion ex vivo confocal microscopy: a promising change in conventional skin histopathology. Br J Dermatol. 2020;182(2):468-476. https://doi.org/10.1111/bjd.18239
Brantsch KD, Meisner C, Schönfisch B, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713-720. https://doi.org/10.1016/S1470-2045(08)70178-5
Cooper JZ, Brown MD. Special concern about squamous cell carcinoma of the scalp in organ transplant recipients. Arch Dermatol. 2006;142(6):755-758. https://doi.org/10.1001/archderm.142.6.755
Amin MB, Edge S, Greene F, et al, eds. AJCC Cancer Staging Manual, 8th ed. Berlin, Heidelberg: Springer-Verlag; 2017;67(2):93-99. https://doi.org/10.1007/978-3-319-40618-3
National Comprehensive Cancer Center. NCCN clinical practice guidelines in oncology; squamous cell carcinoma (V1.2017). Available from: www.nccn.org. URL: https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed December 2019.
Karia PS, Jambusaria-Pahlajani A, Harrington DP, Murphy GF, Qureshi AA, Schmults CD. Evaluation of American Joint Committee on Cancer, International Union Against Cancer, and Brigham and Women’s Hospital tumor staging for cutaneous squamous cell carcinoma. J Clin Oncol. 2014;32(4):327-334. https://doi.org/10.1200/JCO.2012.48.5326
Mohs FE. Chemosurgery for the microscopically controlled excision of skin cancer. J Surg Oncol. 1978;1(2):150-166. https://doi.org/10.1002/jso.2930030307
Ad Hoc Task Force, Connolly SM, Baker DR, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery [published correction appears in J Am Acad Dermatol. 2015 Apr;72(4):748]. J Am Acad Dermatol. 2012;67(4):531-550.
Lansbury L, Bath-Hextall F, Perkins W, Stanton W, Leonardi-Bee J. Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies. BMJ. 2013;347:f6153. https://doi.org/10.1136/bmj.f6153
Grossi Marconi D, Da Costa Resende B, Rauber E, et al. Head and neck non-melanoma skin cancer treated by superficial x-ray therapy: an analysis of 1021 cases. PLoS One. 2016;11(7):e0156544. https://doi.org/10.1371/journal.pone.0156544
Maubec E, Petrow P, Scheer-Senyarich I, et al. Phase II study of cetuximab as first-line single-drug therapy in patients with unresectable squamous cell carcinoma of the skin. J Clin Oncol. 2011;29(25):3419-3426. https://doi.org/10.1200/JCO.2010.34.1735
Foote MC, McGrath M, Guminski A, et al. Phase II study of single-agent panitumumab in patients with incurable cutaneous squamous cell carcinoma. Ann Oncol. 2014;25(10):2047-2052. https://doi.org/10.1093/annonc/mdu368
Seiwert TY, Burtness B, Mehra R, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol. 2016;17(7):956-965. https://doi.org/10.1016/S1470-2045(16)30066-3
Migden MR, Rischin D, Schmults CD, et al. PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med. 2018;379(4):341-351. https://doi.org/10.1056/NEJMoa1805131
Published
Issue
Section
License
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
