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“Intraepidermal” means that the cancerous cells are located in the epidermis from where they originally developed (in situ). Squamous cell carcinoma in situ (SCCIS) is a vitiated, superficial growth of cancerous cells on the skin’s outer layer. It is not a severe condition but could develop into a full form of invasive skin cancer if not detected early or well managed. It is also known as carcinoma in situ in the literature or as Bowen disease after John T. Bowen, an American dermatologist who first described the condition in 1912. Flat cells, known as squamous cells, are located in the epidermis. They are responsible for the production of the keratin protein and affected by this condition. This activity reviews the evaluation of intraepidermal squamous cell carcinoma in situ and identifies the role of the interprofessional team in managing this condition.
- Review the etiology of squamous cell carcinoma in situ.
- Describe the technique of diagnosis of squamous cell carcinoma in situ.
- Summarize the treatment of squamous cell carcinoma in situ.
- Outline the evaluation of intraepidermal squamous cell carcinoma in situ and identify the role of the interprofessional team in managing this condition.
“Intraepidermal” means that the cancerous cells are located in the epidermis from where they originally developed (in situ). Squamous cell carcinoma in situ (SCCIS) is a vitiated, superficial growth of cancerous cells on the skin’s outer layer. It is not a severe condition but could develop into a full form of invasive skin cancer if not detected early or well managed. It is also known ascarcinoma in situ in the literature or asBowen disease after John T. Bowen, an American dermatologist who first described the condition in 1912. Flat cells, known as squamous cells,are located in the epidermis. They are responsible for the production of the keratin protein andaffected by this condition.
Intraepidermal or squamous cell carcinoma in situ was first attributed to exposure of unprotected body parts to ionizing radiation in the year 1920. However, population studies today show that the most common cause of carcinoma is long-term exposure of the skin and dermal layers to sunlight. Ultraviolet radiationdamages the skin cell nucleic acids, leading to the mutation and cloning of the p53 gene. The resulting exposure to ultraviolet UV radiation leads to a geometric growth of skin cells. Auto function cell repairsalsoare impeded by exposure to ultraviolet (UV) from sunlight. Diseases or drugs capable of suppressing immune responses to skin damagealsocan trigger the mutation of squamous cells. Other causatives attributed to intraepidermal squamous cell carcinomainclude arsenic ingestion and some viral infections.
A Minnesota study of the disease'sfrequency inUS populationin 1991reported the annual average case of squamous cell carcinoma (SCC) in situto be 14.9 cases per 100,000 whites. In 1994, it was recorded that the frequency had multiplied by a geometric factor of 10. The disease is usually frequent and most reported in whites and rarely in people who have a dark-pigmented skin. Thediseasehas an equal ratio of distribution across both genders andoftencanoccurin middle-aged and elderly patients.
Squamous cell carcinoma (SCC) is a malignant form of keratinocyte skin cancer. It appears as pigmented or verrucous tumor forms and can progressively develop into squamous cell carcinoma. A common feature is the simultaneous occurrence of basal cell carcinoma in patients with conditions of squamous cell carcinoma.
Microscopic examination is of great importance, especially for the diagnosis of squamous cell carcinoma in situ. It considers the features of the specimen obtained via biopsy regarding invasion, differentiation, and depth. Note that biopsy specimens usually include samples of the normal tissue which would be used in spotting the differences; also, there is the need for a full thickness biopsy to determine the depth of lesion and invasion levels correctly. Histopathologically, hyperkeratosis, and parakeratosis is noted in the epidermis. Prominent acanthosis along with elongation and thickening of the rete ridges is usually observed. These changeover highly atypical keratinocyte cells. The atypical cells span the full thickness of the epidermis and demonstrate mitotic activity, pleomorphism, and enlarged nuclei. In some cases, hair follicle involvement is observed. The upper epidermis cells might undergo vacuolization and show an abundant and strongly eosinophilic cytoplasm.
History and Physical
Usually, squamous cell carcinoma in situ (SCCIS) affects sun-exposed areas on the skin of the head and neck, and there are also cases of it arising on the trunk. In the early stages of Bowen disease, virus lesions appear on the skin in the form of red, scaly patches, and as it progresses, it develops into nodules or plagues which are prone to ulceration.
The gold standard of diagnosis for carcinoma in situ is a skin biopsy; a shave or punch biopsy can be used. Biopsy samples should be taken from the suspected carcinoma in situ and its surrounding tissues and then sent to a dermatopathologist for adequate pathologic analysis.
A complete skin examination is mandatory for patients with suspected squamous cell carcinoma in situ. The examination should be on both sun-exposed and non-exposed areas.
Treatment / Management
Histological mapping and local excision of the carcinoma is the standard form of treatment. Other treatment options prescribed by dermatologists for early lesions include the use of topical creams like imiquimod or 5-fluorouracil; these two drugs are topical immune response modifier, and topical antineoplastic agent respectively. X-ray or Grenz-ray radiation therapy also can be applied for patients with multiple lesions. Photodynamic therapy is another treatment option that has shown great success in the management of squamous cell carcinoma in situ (SCCIS) involves injecting a photosensitizing agent which is absorbed by the tumor. A light source is then used to stimulate the injected agent, and this triggers tumor destruction.
The symptoms of squamous cell carcinoma in situare similar to those of other diseases or conditions, so itis important not to mistake itssymptoms. Diseases that should be differentiated and ruled out to reach a conclusive diagnosis of squamous cell carcinoma in situinclude atopic dermatitis, pyoderma gangrenosum, Bowenoid papulosis, atypical fibroxanthoma, melanoma in situ, and Paget disease.
The risk rate of the disease progressing to full, invasive squamous cell carcinoma is minimal and around 3% to 5%. A study of previous cases with mutually probable biases reported that of the 3% to 5% develop to invasive squamous cell carcinoma one-third could metastasize. For erythroplasia of Queyrat or genital Bowen disease, the risks are estimated to be higher. After surgical excision, if negative margins are not achieved, there is a risk of recurrence.
Pearls and Other Issues
In its early stages, it can be misdiagnosed as eczema, psoriasis, or even ringworm. It may develop into an invasive cancer if it is not treated early. The most common cause of squamous cell carcinoma in situis undue exposure to the sun’s rays; therefore, in preventing one’s susceptibility to the disease, there should be a limit to sun exposure. The use of sunscreen, photoprotective clothing, and other means that could minimize exposure to sun rays are helpful prevention tips. Regular testing and screening are also important, especially in people at high risk for squamous cell carcinoma in situ. Early detection has a very good prognosis and prevents the development of squamous cell carcinoma.
Enhancing Healthcare Team Outcomes
Patients with skin lesions often present to the emergency department, primary care physician, nurse practitioner or the internist. However, if there is suspicion about cancer the patient is best referred to a dermatologist. Without a biopsy, it is impossible to make the diagnosis of early skin cancer. While the dermatologist will undertake definitive workup, the primary care provider, nurse practitioner and pharmacist should emphasize the importance of prevention by limiting sun exposure.
The use of sunscreen, photoprotective clothing, and other means that could minimize exposure to sun rays are helpful prevention tips. Regular testing and screening are also important, especially in people at high risk for squamous cell carcinoma in situ. Early detection has a very good prognosis and prevents the development of squamous cell carcinoma.
Amanda M. Oakley
9/12/2022 9:11:34 PM
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In general, the squamous cell carcinoma survival rate is very high—when detected early, the five-year survival rate is 99 percent. Even if squamous cell carcinoma has spread to nearby lymph nodes, the cancer may be effectively treated through a combination of surgery and radiation treatment.How serious is Bowen's disease? ›
Is Bowen's disease serious? Bowen's disease itself is not usually serious. It tends to grow very slowly over months or years, and there are several very effective treatments for it.What are the three types of carcinoma? ›
carcinoma – this cancer begins in the skin or in tissues that line or cover internal organs. There are different subtypes, including adenocarcinoma, basal cell carcinoma, squamous cell carcinoma and transitional cell carcinoma.How serious is carcinoma skin cancer? ›
Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive. Untreated, squamous cell carcinoma of the skin can grow large or spread to other parts of your body, causing serious complications.What are the first signs of squamous cell carcinoma? ›
- Rough, reddish scaly patch.
- Open sore (often with a raised border)
- Brown spot that looks like an age spot.
- Firm, dome-shaped growth.
- Wart-like growth.
- Tiny, rhinoceros-shaped horn growing from your skin.
- Sore developing in an old scar.
Symptoms of stage 4 squamous cell carcinoma usually begin with some kind of skin lesion or growth. Often, the tumors of squamous cell carcinoma look like a scaly red patch of skin that won't heal. These tumors are often crusty and raised, and they may cause sores or ulcers that last for several weeks.Is Intraepidermal carcinoma malignant? ›
Recurrent intraepidermal carcinoma of the scalp: A common skin malignancy presenting important management considerations on a high-risk site.Can you live a long life with squamous cell carcinoma? ›
Most (95% to 98%) of squamous cell carcinomas can be cured if they are treated early. Once squamous cell carcinoma has spread beyond the skin, though, less than half of people live five years, even with aggressive treatment.Is Bowen's disease benign or malignant? ›
Bowen's disease is a cancerous condition. It involves scaly patches that can turn into skin cancer over time. The most common cause is prolonged sun exposure, but HPV infections, arsenic exposure, and a compromised immune system can also play a role.What are the top 3 deadliest cancers? ›
Lung and bronchus cancer is responsible for the most deaths with 130,180 people expected to die from this disease. That is nearly three times the 52,580 deaths due to colorectal cancer, which is the second most common cause of cancer death. Pancreatic cancer is the third deadliest cancer, causing 49,830 deaths.
What's the difference between cancer and carcinoma? Carcinoma is a type of cancer that forms in epithelial tissue. Other types of cancer form elsewhere, such as in connective tissue (sarcoma), bone marrow (leukemia), etc. Most cancer diagnoses are carcinoma.What is the best treatment for carcinoma? ›
Chemotherapy: Chemotherapy treats carcinoma with drugs designed to destroy cancer cells, either throughout the whole body, or in a specific area. In some cases, chemotherapy may be used in combination with other treatments, such as radiation therapy or surgery.What is the deadliest skin cancer? ›
Melanoma is often called "the most serious skin cancer" because it has a tendency to spread. Melanoma can develop within a mole that you already have on your skin or appear suddenly as a dark spot on the skin that looks different from the rest.What is the hardest skin cancer to treat? ›
Melanoma is not as common as basal cell or squamous cell carcinomas but is the most dangerous form of skin cancer. If left untreated or caught in a late-stage, melanomas are more likely to spread to organs beyond the skin, making them difficult to treat and potentially life-limiting.What happens if carcinoma is left untreated? ›
And even if untreated carcinomas don't result in death, they can lead to large, open lesions on the skin that can cause discomfort, embarrassment, and infection.What does stage 1 squamous cell carcinoma look like? ›
Squamous cell carcinoma initially appears as a skin-colored or light red nodule, usually with a rough surface. They often resemble warts and sometimes resemble open bruises with raised, crusty edges. The lesions tend to develop slowly and can grow into a large tumor, sometimes with central ulceration.What age do people get squamous cell carcinoma? ›
Age over 50: Most SCCs appear in people over age 50. Fair skin: People with fair skin are at an increased risk for SCC. Gender: Men are more likely to develop SCC. Sun-sensitive conditions including xeroderma pigmentosum.How long does it take for squamous cell carcinoma to spread? ›
Metastasis of cutaneous squamous cell carcinoma (cSCC) is rare. However, certain tumor and patient characteristics increase the risk of metastasis. Prior studies have demonstrated metastasis rates of 3-9%, occurring, on average, one to two years after initial diagnosis .How do you know if squamous cell carcinoma has spread to lymph nodes? ›
Squamous cell cancers can metastasize to nearby lymph nodes or other organs, and can invade both small and large nerves and local structures. Biopsy can help determine if the squamous cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment.How long can you live with Stage 4 squamous cell carcinoma? ›
The prognosis of patients with recurrent or metastatic head and neck squamous cell cancer is generally poor. The median survival in most series is 6 to 15 months depending on patient- and disease-related factors.
When squamous cell cancer spreads to lymph nodes in the neck or around the collarbone, it is called metastatic squamous neck cancer. The doctor will try to find the primary tumor (the cancer that first formed in the body), because treatment for metastatic cancer is the same as treatment for the primary tumor.What is the difference between malignant and carcinoma? ›
Malignant cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of malignancy. Carcinoma is a malignancy that begins in the skin or in tissues that line or cover internal organs.Is Intraepidermal carcinoma the same as SCC? ›
Intraepidermal squamous cell carcinoma (SCC) is a common superficial form of keratinocyte cancer. It is also known as Bowen disease, intraepidermal carcinoma (IEC) and carcinoma in situ (SCC in situ).What is the most common malignant epithelial tumor? ›
Carcinoma. Carcinoma refers to a malignant neoplasm of epithelial origin or cancer of the internal or external lining of the body. Carcinomas, malignancies of epithelial tissue, account for 80 to 90 percent of all cancer cases.What kills squamous cell carcinoma? ›
Chemotherapy. Chemotherapy uses powerful drugs to kill cancer cells. If squamous cell carcinoma spreads to the lymph nodes or other parts of the body, chemotherapy can be used alone or in combination with other treatments, such as targeted drug therapy and radiation therapy.Do you need chemo for squamous cell carcinoma? ›
If squamous cell carcinoma has spread, chemo might be an option, although an immunotherapy drug might be used first. If chemo is used, drugs such as cisplatin and 5-fluorouracil (5-FU) might be options. These drugs are given into a vein (intravenously, or IV), usually once every few weeks.How long is chemotherapy for squamous cell carcinoma? ›
Applied by a patient at home over the course of approximately three to six weeks.Is Bowen's disease malignant? ›
Ulceration or hardening (induration) of a skin lesion also indicates malignant transformation. Bowen disease is classified as an early, noninvasive form of squamous cell carcinoma, a type of skin cancer that most often occurs on sun damage areas of the skin.Is Bowen's disease curable? ›
Bowen's disease can be cured with a variety of treatments, including freezing, scraping, surgical removal or a special cream. However, if the patch is not troublesome, your doctor may simply suggest that it is kept under observation. It is worthwhile protecting your skin from the sun once you have Bowen's disease.What is the difference between Bowen's disease and squamous cell carcinoma? ›
Bowen's disease is sometimes called squamous cell carcinoma in situ. If it is not treated, it can occasionally develop into squamous cell carcinoma (SCC). This happens in a small number of people (about 3 to 5 out of every 100 who have Bowen's disease). SCC is a common, curable type of skin cancer.
- Pancreatic cancer.
- Gallbladder cancer.
- Esophageal cancer.
- Liver and intrahepatic bile duct cancer.
- Lung and bronchial cancer.
- Pleural cancer.
- Acute monocytic leukemia.
Cancer survival rates by cancer type
The cancers with the lowest five-year survival estimates are mesothelioma (7.2%), pancreatic cancer (7.3%) and brain cancer (12.8%). The highest five-year survival estimates are seen in patients with testicular cancer (97%), melanoma of skin (92.3%) and prostate cancer (88%).
Your oncologist may recommend avoiding chemotherapy if your body is not healthy enough to withstand chemotherapy or if there is a more effective treatment available.Does carcinoma spread fast? ›
Squamous cell carcinoma rarely metastasizes (spreads to other areas of the body), and when spreading does occur, it typically happens slowly. Indeed, most squamous cell carcinoma cases are diagnosed before the cancer has progressed beyond the upper layer of skin.Can carcinoma be cured without surgery? ›
Radiation therapy has localised and temporary complications, which are easily manageable with medications. It helps in preserving the functional status of the organs, unlike surgery. The majority of the cancers are treated by radiotherapy either alone or in combination with surgery or chemotherapy. – By Dr.Does carcinoma cause death? ›
For some people, the cancer can't be controlled anymore and spreads to healthy tissues and organs. Cancer cells take up the needed space and nutrients that the healthy organs would use. As a result, the healthy organs can no longer function. For other people, complications from treatment can cause death.Can carcinoma be removed? ›
Surgery. Basal cell carcinoma is most often treated with surgery to remove all of the cancer and some of the healthy tissue around it.Which food is good for carcinoma? ›
Some of the best foods to eat during chemotherapy or other cancer treatments are plant-based proteins. They offer the highest levels of vitamins and minerals, Rajagopal says. This means eating lots of vegetables as well as beans, legumes, nuts and seeds.How do they remove a carcinoma? ›
Mohs surgery is considered the most effective technique for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), the two most common types of skin cancer. Sometimes called Mohs micrographic surgery, the procedure is done in stages, including lab work, while the patient waits.What is the slowest spreading skin cancer? ›
Basal cell carcinoma accounts for more than 90 percent of all skin cancers in the United States and is the most common of all cancers. Typically, it is a slow-growing cancer that seldom spreads to other parts of the body.
Merkel cell carcinoma tends to grow fast and to spread quickly to other parts of your body. Treatment options for Merkel cell carcinoma often depend on whether the cancer has spread beyond the skin.What is the most treatable skin cancer? ›
Melanoma is the most invasive skin cancer with the highest risk of death. While it's a serious skin cancer, it's highly curable if caught early.Where does skin cancer spread first? ›
Doctors have known for decades that melanoma and many other cancer types tend to spread first into nearby lymph nodes before entering the blood and traveling to distant parts of the body.What is the easiest skin cancer to cure? ›
The most common skin cancers, basal cell carcinoma and squamous cell carcinoma, are nonmelanoma skin cancers and rarely life threatening. They grow slowly, seldom spread beyond the skin, are easily found, and usually are cured.Which skin cancers has poorest prognosis? ›
Non-melanoma skin cancer that has spread to other parts of the body (called distant metastases) has a very poor prognosis.What is the survival rate of carcinoma? ›
5-year relative survival rates for breast cancer.
|SEER Stage||5-year Relative Survival Rate|
|All SEER stages combined||90%|
In general, the squamous cell carcinoma survival rate is very high—when detected early, the five-year survival rate is 99 percent.Is squamous cell carcinoma a big deal? ›
Although squamous cell carcinoma can be more aggressive than basal cell cancer, the risk of this type of cancer spreading is low—as long as the cancer is treated early, Dr. Leffell says. He notes that the lesions must be treated with respect because they may grow rapidly and invade deeply.How quickly does squamous cell carcinoma spread? ›
Metastasis of cutaneous squamous cell carcinoma (cSCC) is rare. However, certain tumor and patient characteristics increase the risk of metastasis. Prior studies have demonstrated metastasis rates of 3-9%, occurring, on average, one to two years after initial diagnosis .What organs does squamous cell carcinoma affect? ›
If left untreated, squamous cell carcinoma can spread to nearby lymph nodes, bones or distant organs (such as the lungs or liver). Normal squamous tissue usually appears flat. When this tissue develops cancer it can appear as round masses that are can be flat, raised, or ulcerated.
Stage 4 cancer usually can't be cured. In addition, because it's usually spread throughout the body by the time it's diagnosed, it is unlikely the cancer can be completely removed. The goal of treatment is to prolong survival and improve your quality of life.How do I know if my squamous cell carcinoma has metastasized? ›
Metastatic squamous cell carcinoma is often referred to as a neck cancer because it tends to travel to the lymph nodes in the neck and around the collarbone. Because of this, signs of metastasis may include a painful or tender lump in the neck or a sore throat that doesn't improve or go away.How quickly should a squamous cell carcinoma be removed? ›
Treatment should happen as soon as possible after diagnosis, since more advanced SCCs of the skin are more difficult to treat and can become dangerous, spreading to local lymph nodes, distant tissues and organs.Where does squamous cell carcinoma spread first? ›
Hanke: The first place SCCs metastasize to is the regional lymph nodes. So if you have a squamous cell carcinoma on your cheek, for example, it would metastasize to the nodes in the neck. But there are treatments for that. Patients can have surgery, radiation and, in some advanced cases, immunotherapy medication.Can stress cause squamous cell carcinoma? ›
Stress and Skin Cancer
However, stress may also play a role, as it causes the body to produce unstable oxygen molecules called free radicals. Those can increase inflammation and damage your skin's DNA, leading to mutations and, possibly, skin cancer.
Squamous Cell Carcinoma (SCC)
If left untreated, SCC will metastasize, meaning it will grow or spread, affecting the lymph nodes, organs, and possibly bones. SCC is typically most fatal to older adults and individuals with weakened immune systems, but this does not mean that healthy individuals are completely safe.
Most squamous cell skin cancers are found and treated at an early stage, when they can be removed or destroyed with local treatment methods. Small squamous cell cancers can usually be cured with these treatments.