Updated: 11/22/2020

Squamous Cell Carcinoma

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https://upload.orthobullets.com/topic/8073/images/40b_moved.jpg
https://upload.orthobullets.com/topic/8073/images/40a_moved.jpg
https://upload.orthobullets.com/topic/8073/images/Case A - femur - xray a - Parsons_moved.gif
https://upload.orthobullets.com/topic/8073/images/Case A - femur - xray b - Parsons_moved.gif
https://upload.orthobullets.com/topic/8073/images/Case A - femur - MRI T1 - Parsons_moved.gif
https://upload.orthobullets.com/topic/8073/images/Case A - femur - MRI T2 - Parsons_moved.jpg

Introduction
  • Malignant soft tissue tumor found in older patients
  • Epidemiology
    • location
      • dorsum of hand and forearm
      • most common subungual malignancy
    • risk 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  
  • Prognosis
    • metastasis
      • lymph node metastases and high histologic grade confer poor prognosis
      • higher metastatic potential than basal cell carcinoma
Presentation
  • Symptoms
    • pain 
Imaging
  • Radiographs
    • recommended views
      • AP and lateral of affected area
    • findings
      • lytic lesion 
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
Differential & Groups
 
         
Treated with wide-resection alone (2)
   
Squamous cell (3)        
   
Adamantinoma        
   
Chordoma        
   
Chondrosarcoma        
   
Parosteal osteosarcoma        
   
 ASSUMPTIONS: (1) Older patient is > 40 yrs; (2) assuming no impending fracture (3) assuming no metastatic disease
 
Ibank
  Location
Xray
Xray
CT
B. Scan
MRI
MRI
Histo(1)
Case A Finger       
(1) - histology does not always correspond to clinical case 

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Questions (3)
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(OBQ10.190) Which of the following best describes a squamous cell carcinoma that develops as a result of chronic drainage from sinus tracts or a result of burn scars? Tested Concept

QID: 3288
1

Cushing's ulcer

3%

(69/2225)

2

Mooren's ulcer

1%

(29/2225)

3

Chancroid ulcer

2%

(51/2225)

4

Marjolin's ulcer

87%

(1944/2225)

5

Curling's ulcer

5%

(122/2225)

L 2 C

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