Squamous cell carcinoma
Also called SCC, cutaneous squamous cell carcinoma
The keratinocyte cancer that CAN metastasise: a firm, keratotic, often ulcerated and tender nodule on chronically sun-damaged skin, growing over weeks to months, faster than BCC, slower than keratoacanthoma folklore suggests.
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How it looks
A firm, tender, hyperkeratotic crusted nodule with an indurated base on the dorsal hand of a chronically sun-exposed patient, enlarging over three months.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
In deeply pigmented skin SCC arises disproportionately in scars, chronic ulcers, and areas of chronic inflammation (Marjolin ulcer) rather than sun-exposed sites, a changed or newly nodular scar edge deserves biopsy.
Don't miss
Organ-transplant recipients develop SCCs early, often, and aggressively, a low biopsy threshold in the immunosuppressed saves lives.
Symptoms & course
- Tenderness distinguishes it from most of its painless mimics
- Growth over weeks-months; may bleed
Diagnostic approach
- Biopsy any indurated, tender, or growing keratotic lesion
- Palpate regional lymph nodes, this one spreads
Differential, and how to separate them
- Actinic keratosis
Favours it: Flat, rough, sandpaper patch, the precursor
Against it: Induration, tenderness, and thickness mark transformation to SCC
- Basal cell carcinoma
Favours it: Pearly, slow, painless
Against it: SCC is keratotic, tender, and faster
Management principles
- Complete excision with margins
- Radiotherapy or specialist care for high-risk or inoperable disease
- Immunosuppressed patients need aggressive surveillance
Clinical pearl: A 'wart' or 'sore' that hurts, hardens, or grows on sun-damaged skin has earned a biopsy.
Keep going