Squamous cell carcinoma-microscopic appearance, Spread , Treatment
The early appearance of SCC may vary from smooth nodular to vercous, papillomatous and ulcerating lesions. However all the variants will eventually ulcerate as they grow. The ulcer refuses to heal and is covered with a crust. Then the ulcer becomes irregular and has the following characteristics-
- Edge of the ulcer is heaped up and everted.
- Floor of the ulcer is covered by grayish white slough.
- Base of the ulcer is indurated and may be fixed to deeper structure.
Spread of SCC:
Local spread – by continuity and contiguity is generally slow.
- It is common cancer of the foot.
- It is frequent in cancer of the face or neck.
- It is late or absent in case of the hand of an old person, in case of scar or chronic ulcer.
Blood spread – occurs only in very advanced stages.
The overall rate of metastasis is 2% for SCC- usually to regional node.
Treatment of squamous cell carcinoma:
Principle: excision with a margin of 1 cm or more is essential. Reconstruction may be by simple direct suture of the apposed skin margins or may need the partial or full thickness skin graft to cover the defect. Rotational flaps or pedical grafts may be tried for better cosmetic result.
- Lesions are large in size
- Involvement of the muscle,cartilage,bone
- Lesion close to eye
- Lesions in the scalp
- Recurrence after radiotherapy
- Non availability of the radiotherapy
a) Clinically no palpable nodes- regular observation is needed. If appears, radical block dissection is to be performed after biopsy.
b) Lymph nodes are palpable but discrete and mobile- it may be reactive due to infection rather than involved by metastasis. So a course of antibiotic is given postoperative for three weeks and observe
- if the node disappear or diminish-suggestive of infective origin. So further treatment- regular observation.
- if nodes remain unaltered- suggestive of malignancy. So, radical block dissection is to be performed after biopsy.
Overall 95% of local recurrence and regional metastasis occur within 5 years. So, follow up beyond this period is not indicated.