summary Squamous Cell Carcinoma is a malignant soft tissue tumor most commonly found in elderly patients. Diagnosis is made with a biopsy. Treatment is wide surgical resection with or without radiation and skin grafting. Epidemiology Anatomic location dorsum of hand and forearm most common subungual malignancy Riisk factors primary risk factor is excessive exposure to ultraviolet radiation actinokeratosis chronic osteomyelitis Marjolin's ulcer is a squamous cell carcinoma resulting from chronic draining wounds or burn scars Presentation Symptoms pain Imaging Radiographs recommended views AP and lateral of affected area findings lytic lesion Differential Differential of Squamous Cell Carcinoma Treated with wide-resection alone Squamous cell o Adamantinoma o Chordoma o Chondrosarcoma o Parosteal osteosarcoma o Treatment Operative wide surgical resection +/-skin graft +/- radiation indications standard traditional treatment adjunctive radiation indications lesions >2cm wide 4mm deep perineural invasion lymph node metastases Mohs microsurgery indications becoming more popular smaller lesions highest cure rate technique lymph node biopsy may be necessary Prognosis Metastasis lymph node metastases and high histologic grade confer poor prognosis higher metastatic potential than basal cell carcinoma