Epithelioma or squamous cell carcinoma

Epithelioma or squamous cell carcinoma

Introduction

Epithelioma or squamous cell carcinoma it is a malignant tumor or neoplasm which arise from squamous cell layer of the epidermis of the skin  so epithelioma it is a type from skin cancer
Skin cancer can be divided into main types non melanoma skin cancer type which include squamous cell carcinoma SCC and basal cell carcinoma BCC  and melanoma skin cancer type which include malignant melanoma

What are the causes of squamous cell carcinoma

  • Exposure to sunshine
  • Exposure to irradation
  • Exposure to carcinogenic agents such as pitch ,tar, betel nuts
  • Human papilloma virus
  • Immunosuppressive drugs
  • Chronic ulceration such as marjolin,s ulcer is malignant change in a longstanding scar , ulcer or sinus which typically seen in chronic varicose ulcer unhealed burn, sinus of chronic esteomyelitis
  • Lupus valgaris and warts
Marjolin,s ulcer has the following criteria
  • Slowly growing ulcer
  • Painless ulcer
  • Transformed into squamous cell carcinoma
  • Spread to lymphatic late
  • The edge of the ulcer not always raised and everted such as in SCC
  • Unusual nodules or changes in a chronic non healing ulcer or scar should be viewed with suspicion and take biopsy from that lesion early
  • Other features may be masked by the presence of previous ulcer or scar
  • Need vigorous treatment
What are the premalignant condition of the skin
  • Senile or solar keratosis  which usually multiple lesion on the face and backs of the hands in patient past middle life fair skinned appear as dry hard scaly
  • Seborrhoeic keratosis
  • Chronic radiodermatitis
  • Xeroderma pigmentosa
  • Bown,s disease
  • Leukoplakia
Any changes in the pre-exsiting skin lesions such as warts or mole should be rise suspicion of malignant changes such as

If the patient has mole or warts and he notice that
  • It become increased in size
  • It colour become changed either increased or decreased in pigmentation
  • The lesion become itchy
  • The lesion become bleeding
  • The lesion become swollen
  • The lesion become painful
  • The lesion become has fissuring or ulceration
  • The lesion become indurated
  • Spread of pigment as sattelite nodules around it due to lymphatic permeation
Symptoms signs and pathology of squamous cell carcinoma

Squamous cell carcinoma is a common invasive malignant epidermal tumor which can spread to the lymphatic and may give metastasis first lymph node become hard and mobile but later become fixed to deeper structures but rare to give blood metastasis
Very common skin cancer which occur commonly in older aged patient
More common in male than female
Common site at sun exposed areas such as face back of the hands also can occurs in lips gums tongue esophagus genitals and anal margins

Squamous cell carcinoma can be appear as

Hyperkeratotic and crusty on sun damaged skin eg ear pinna
Friable or papilliferous varities
Malignant ulcer or squamous cell carcinoma ulcer which have the following criteria
  • Size small or moderate or large size
  • Edge of the ulcer raised everted nodular edges
  • Base of the ulcer hard indurated and is often fixed to the deeper structures
  • Floor of the ulcer irregular composed of necrotic material scab or haemorrhagic tumor tissue
Pathology of squamous cell carcinoma
Malignant or carcinomatous ulcer as above when see by the eye
Solid columns of epithelial cells growing into the dermis with epithelial pearls or nest of central keratin surrounded by prickle cells this is see under microscope
Treatment of squamous cell carcinoma
There are different ways to treated squamous cell carcinoma such as
Surgical removal or excision
Surgical removal of the lesion with safety margins to avoid it is recurrence and the defect left is closed by plastic skin flap or grafts
Irradiation therapy
Which can be used in multiple session
  
contraindication
 Very small ulcer because it is better to surgical removal
Ulcer near the eye to protect eye against irradiation effect  but this can be protected by using a lead shield
Ulcer infiltrating the bone or cartilage because the cancer cells become hidden and efficient dose will causes irradiation bone or cartilage necrosis and if small dose it will be carry the risk of recurrence
 Recurrent ulcer
Cases resistant to irradiation
For more about cancer treatment by radiotherapy see here
 
Currettage and cautery
In this methods the lesion is currette by using spoon like called currette followed by using electric current called cautery to kill or destroyed malignant cells
Cryosurgery
In this method a cryo device is used to freeze the lesion and kills the cancer cells using nitrogen liquid
Topical chemotherapy
Local treatment by using 5- flurouracil in small and superficial lesions but recurrent rate is high than with other forms of treatment
Treatment of the regional lymph nodes
If the lymph nodes are involved the block lymph nodes dissection is indicated
How cancer skin can be prevented see here
 For basal cell carcinoma or rodent ulcer see here
For malignant melanoma see here
 

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