Cutaneous Squamous Cell Carcinoma (CSCC) : Clinical Features and Diagnosis - UpToDate

Cutaneous squamous cell carcinoma (cSCC): Clinical features and diagnosis - UpToDate 1/03/23, 6:27 p.m.
Official reprint from UpToDate®

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Cutaneous squamous cell carcinoma (cSCC): Clinical

features and diagnosis
Authors: Jean Lee Lim, MD, Maryam Asgari, MD, MPH
Section Editors: Robert S Stern, MD, June K Robinson, MD
Deputy Editor: Rosamaria Corona, MD, DSc
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jan 2023. | This topic last updated: Oct 20, 2022.
INTRODUCTION
Cutaneous squamous cell carcinoma (cSCC) is a malignant tumor arising from epidermal
keratinocytes [1]. In individuals with lightly pigmented skin, it typically develops in areas of
photodamaged skin and presents with a wide variety of cutaneous lesions, including
papules, plaques, or nodules, that can be smooth, hyperkeratotic, or ulcerated
( picture 1A-B). A skin biopsy is required to confirm the diagnosis. Biopsies also provide
information that is useful for staging and management.
The clinical presentation and diagnosis of cSCC will be reviewed here. The epidemiology and
risk factors for the development of squamous cell carcinoma (SCC) and the treatment of cSCC
are reviewed separately.
● (See "Cutaneous squamous cell carcinoma: Epidemiology and risk factors".)

● (See "Treatment and prognosis of low-risk cutaneous squamous cell carcinoma (cSCC)".)
● (See "Recognition and management of high-risk (aggressive) cutaneous squamous cell
carcinoma".)
● (See "Systemic treatment of advanced basal cell and cutaneous squamous cell
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carcinomas not amenable to local therapies".)

● (See "Evaluation for locoregional and distant metastases in cutaneous squamous cell
and basal cell carcinoma".)
CLINICAL FEATURES
Location — cSCC can develop on any cutaneous surface, including the head, neck, trunk,
extremities, oral mucosa, periungual skin, and anogenital areas ( picture 2A-D). In
individuals with lightly pigmented skin, cSCCs most commonly arise in sites frequently
exposed to the sun.
Non-sun-exposed areas represent the most common location for cSCC in individuals with
darkly pigmented skin. In Black individuals, common sites for cSCC include the lower legs,
anogenital region, and areas of chronic inflammation or scarring [2-6]. Lesions that develop
in relation to chronic scarring processes account for 20 to 40 percent of cSCCs in Black
patients [2]. (See "Cutaneous squamous cell carcinoma: Epidemiology and risk factors",
section on 'Skin pigmentation and ancestry' and "Cutaneous squamous cell carcinoma:
Epidemiology and risk factors", section on 'Chronic inflammation'.)
Genital and periungual cSCC lesions are less common and are usually related to infection
with high-risk human papillomavirus (HPV) [7]. (See "Cutaneous squamous cell carcinoma:
Epidemiology and risk factors", section on 'Human papillomavirus infection'.)
Genital lesions may also arise as a consequence of the administration of psoralen plus
ultraviolet A (PUVA) phototherapy without genital shields [8]. Of note, tumors arising on the
ear, preauricular surfaces, or at mucocutaneous interfaces (ie, lips, genitalia, and perianal
area) tend to be more aggressive, with rates of metastasis estimated to range from 10 to 30
percent [9-11]. (See "Recognition and management of high-risk (aggressive) cutaneous
squamous cell carcinoma", section on 'Clinical features'.)
Cutaneous squamous cell carcinoma in situ (Bowen's disease) — cSCC in situ (Bowen's

disease) typically presents as an erythematous, well-demarcated, scaly patch or plaque
( picture 3A-B) located in sun-exposed areas, such as the head and neck and extremities.
Lesions can also be skin colored or pigmented, particularly in individuals with darkly
pigmented skin. Lesions of cSCC in situ tend to grow slowly, enlarging over the course of
years. Unlike the inflammatory disorders that may resemble cSCC in situ, such as psoriasis or
chronic eczema, cSCC in situ lesions are usually asymptomatic. (See 'Differential diagnosis'
below.)
"Erythroplasia of Queyrat" is a term used to describe cSCC in situ involving the penis. This
condition presents as a well-defined, velvety, red plaque ( picture 2D). Patients may
experience pain, bleeding, or pruritus. (See "Carcinoma of the penis: Clinical presentation,
diagnosis, and staging", section on 'Premalignant lesions'.)
Invasive cutaneous squamous cell carcinoma — The clinical appearance of invasive cSCC

often correlates with the level of tumor differentiation. Well-differentiated lesions usually
appear as indurated or firm, hyperkeratotic papules, plaques, or nodules
( picture 1A-B, 2A, 2E). Lesions are usually 0.5 to 1.5 cm in diameter but may be much
larger. Ulceration may or may not be present.
In contrast, poorly differentiated lesions are usually fleshy, granulomatous papules or

nodules resembling pyogenic granuloma that lack the hyperkeratosis that is often seen in
well-differentiated lesions ( picture 4A-B). Poorly differentiated tumors may have
ulceration, hemorrhage, or areas of necrosis.
Lesions of invasive cSCC are often asymptomatic but may be painful or pruritic. Local
neurologic symptoms (eg, numbness, stinging, burning, paresthesias, paralysis, or visual
changes) occur in approximately one-third of patients with high-risk cSCC showing histologic
perineural invasion [12]. (See "Recognition and management of high-risk (aggressive)
cutaneous squamous cell carcinoma", section on 'Clinical features'.)
CLINICAL VARIANTS
Keratoacanthoma — Keratoacanthomas are keratocytic epithelial tumors that clinically and

histologically resemble squamous cell carcinoma (SCC). It is controversial whether
keratoacanthomas represent a subtype of well-differentiated cSCC or a separate entity.
Keratoacanthomas are usually found on actinically damaged skin. Lesions typically exhibit
rapid initial growth, manifesting as dome-shaped or crateriform nodules with a central
keratotic core that develop within a few weeks ( picture 5). (See "Keratoacanthoma:
Epidemiology, risk factors, and diagnosis".)
Verrucous carcinoma — Verrucous carcinoma is a rare variant of cSCC that presents with

well-defined, exophytic, cauliflower-like growths that resemble large warts. Lesions are
subclassified according to site:
● Oral florid papillomatosis – Verrucous carcinoma of the oral mucosa ( picture 6A-B)
● Anogenital (also known as giant condyloma acuminatum of Buschke-Löwenstein)

– Verrucous carcinoma involving the penis, scrotum, or perianal region ( picture 7)
(see "Carcinoma of the penis: Epidemiology, risk factors, and pathology", section on
'Pathology')
● Epithelioma cuniculatum – Verrucous carcinoma on the plantar foot ( picture 8)
Verrucous carcinoma may also occur in other locations.
Cutaneous squamous cell carcinoma of the lip — SCC of the lip primarily occurs on the
lower lip. Lesions may present as nodules, ulcers, or indurated, white plaques ( picture 9).
(See "Oral lesions", section on 'Oral squamous cell carcinoma'.)
Oral squamous cell carcinoma — Oral SCC usually presents as an ulcer, nodule, or

indurated plaque involving the oral cavity ( picture 2C, 2F). The floor of the mouth and
lateral or ventral tongue are the most common sites for these tumors. Lesions may arise in
sites of erythroplakia (premalignant, persistent, red patches in the oral cavity) or leukoplakia
(oral, persistent, white plaques) ( picture 10). Oral SCC is often associated with a history of
tobacco or heavy alcohol use. (See "Oral leukoplakia" and "Oral lesions", section on 'Oral
squamous cell carcinoma'.)
Marjolin's ulcer — "Marjolin's ulcer" is a term used to describe a rare type of cSCC arising in
sites of chronic wounds or scars [13-15]. The malignant transformation is usually slow, with
an average latency time of approximately 30 years [13,16].
The tumor may initially present as an ulceration that fails to heal; nodules may develop as
the lesion progresses. Other clinical signs include rolled or everted wound margins, excessive
granulation tissue, rapid increase in size, and bleeding on touch.
SCCs arising in the setting of chronic wounds or scars are typically aggressive and are
associated with a poor prognosis [17]. The risk of local recurrence after treatment or
metastasis is approximately 20 to 30 percent [13,18-20].
Lymphoepithelioma-like carcinoma of the skin — Primary lymphoepithelioma-like

carcinoma of the skin is a very rare, indolent, malignant skin tumor of epithelial origin,
considered a variant of cSCC [21]. Clinically, it presents as a flesh-colored, firm nodule or
plaque, most often located in the head and neck region. Histopathologically, it shows islands
of poorly differentiated epithelial cells with a dense lymphoid infiltrate, resembling
undifferentiated nasopharyngeal carcinoma. (See "Epidemiology, etiology, and diagnosis of
nasopharyngeal carcinoma".)
DIAGNOSIS
Although clinical and dermoscopic findings may strongly suggest a diagnosis of cSCC,
histopathologic examination is necessary to confirm the diagnosis. Histopathologic
examination is also useful for assessment for perineural invasion, tumor differentiation, and
tumor depth, factors that are important for tumor staging and prognosis. (See 'Staging'
below.)
Dermoscopy — On dermoscopic examination, cSCC in situ (Bowen's disease) displays dotted

and/or glomerular vessels, white to yellowish surface scales, and a red-yellowish background
color ( picture 11). Pigmented cSCC in situ typically shows a structureless, brown pattern
with hypopigmented areas (skin colored or white) often eccentrically located and brown dots
arranged as radial lines at the periphery ( picture 12). Key dermoscopic features of invasive
cSCC are white circles; white, structureless areas; and hairpin and linear-irregular vessels
( picture 13). (See "Dermoscopic evaluation of skin lesions", section on 'Criteria for
squamous cell carcinoma' and "Dermoscopy of facial lesions", section on 'Invasive squamous
cell carcinoma'.)
Biopsy and histopathology — Shave, punch, or excisional biopsies may be used for

diagnosis. Regardless of the biopsy technique selected, for lesions that are papular, nodular,
or otherwise suspicious for invasive cSCC, biopsies that extend at least into the mid-reticular
dermis are preferred to allow for adequate evaluation of invasive disease [22]. More
superficial biopsies may be performed in patients with lesions that are suggestive of in situ
squamous cell carcinoma (SCC). (See "Skin biopsy techniques".)
When submitting biopsy specimens for histopathologic diagnosis, important elements that
should be provided to the pathologist include anatomic location of the tumor, clinical size of
the lesion, and whether the patient has additional risk factors for cSCC, such as
immunosuppression, radiation therapy, or solid organ transplantation [22]. Histopathologic
evaluation of skin biopsy specimens is ideally performed by a dermatologist or pathologist
who is experienced in diagnosing cutaneous tumors.
Cutaneous squamous cell carcinoma in situ — cSCC in situ (Bowen's disease) is diagnosed

when histopathologic examination reveals keratinocytic dysplasia involving the full thickness
of the epidermis without infiltration of atypical cells into the dermis [23,24]. The
keratinocytes are pleomorphic with hyperchromatic nuclei, and numerous mitoses are
present. Frequently, there is associated thickening of the epidermis (acanthosis), as well as
hyperkeratosis and parakeratosis of the stratum corneum. In contrast to cSCC in situ, actinic
keratoses demonstrate only partial-thickness epidermal dysplasia.
Invasive cutaneous squamous cell carcinoma — Invasive cSCCs have dysplastic

keratinocytes involving the full thickness of the epidermis that penetrate the epidermal
basement membrane to involve the dermis or deeper tissues. Well-differentiated cSCCs
contain atypical keratinocytes that are slightly enlarged with abundant amounts of
cytoplasm. Keratinization is usually present. In poorly differentiated cSCC, keratinocytes are
anaplastic, with little evidence for differentiation or keratinization. Multiple mitoses are often
seen. Occasionally, the keratinocytic origin of the cells can only be determined by
immunohistochemical stains. Perineural infiltration, a recognized risk factor for recurrence
and metastasis, can be noted more frequently in poorly differentiated cSCC.
Several histopathologic variants of invasive cSCC exist, including spindle cell SCC, acantholytic
(adenoid) cSCC, clear cell cSCC, adenosquamous (mucin-producing) cSCC, desmoplastic cSCC,
single-cell cSCC, and others [25-27].
DIFFERENTIAL DIAGNOSIS
Multiple other skin lesions, including premalignant, malignant, and inflammatory lesions,
can resemble cSCC clinically and, in some cases, histopathologically. In particular, superficial
basal cell carcinoma and cSCC in situ are especially difficult to differentiate clinically and
dermoscopically from each other and sometimes from a psoriasis plaque.
Premalignant lesions
Actinic keratoses — The most common clinical diagnostic dilemma involves actinic

keratoses. Actinic keratoses are rough, scaly, erythematous macules that develop on sun-
damaged skin and demonstrate keratinocytic atypia on histopathologic examination
( picture 14). Although the rate of transformation of actinic keratoses to squamous cell
carcinoma (SCC) is very low, estimated at less than 1 percent in one year, approximately 60
percent of SCCs arise from actinic keratoses [28-30].
Actinic keratoses are often found in close proximity to cSCCs and can resemble cSCC in situ or
early cSCC. Tenderness, bleeding, and palpable underlying substance suggest the possibility
of cSCC and indicate the need for biopsy. (See "Epidemiology, natural history, and diagnosis
of actinic keratosis".)
Bowenoid papulosis — Bowenoid papulosis is a premalignant focal epidermal dysplasia

characterized by multiple red- to brown-colored, small papules that primarily arise on
genitals, although extragenital cases have also been reported ( picture 15) [31]. The
condition is classified as a transitional state between genital warts and SCC in situ.
Bowenoid papulosis is induced by human papillomavirus (HPV) infection. Although the most
common inciting agent is HPV 16, other HPV types have been implicated [32]. On
histopathologic examination, lesions demonstrate focal epidermal hyperplasia and partial-
thickness to full-thickness epidermal dysplasia [33].
The rate of malignant transformation of bowenoid papulosis to SCC is low (estimated to be 1

to 2.6 percent), and the majority of lesions can be treated successfully with simple, local
destruction or topical immunomodulators [34,35]. Because bowenoid papulosis has the
potential to undergo malignant transformation, follow-up evaluation is warranted if the
lesions recur or undergo rapid enlargement. (See "Carcinoma of the penis: Clinical
presentation, diagnosis, and staging".)
Inflammatory skin disorders — The well-demarcated, scaling, pink plaques of cSCC in situ

can resemble inflammatory skin disorders, including:
● Nummular eczema ( picture 16) (see "Nummular eczema")
● Psoriasis ( picture 17) (see "Psoriasis: Epidemiology, clinical manifestations, and

diagnosis")
● Inflamed seborrheic keratosis ( picture 18) (see "Overview of benign lesions of the
skin", section on 'Seborrheic keratosis')
● Prurigo nodularis ( picture 19A-B) (see "Prurigo nodularis")
● Pyoderma gangrenosum ( picture 20A-B) (see "Pyoderma gangrenosum:

Pathogenesis, clinical features, and diagnosis")
● Venous stasis ulcers ( picture 21) (see "Clinical assessment of chronic wounds",
section on 'Venous ulcers')
Other malignant skin tumors — A number of malignant skin tumors may share clinical
features with cSCC:
● Merkel cell carcinoma ( picture 22A-B) (see "Pathogenesis, clinical features, and
diagnosis of Merkel cell (neuroendocrine) carcinoma")
● Basal cell carcinoma ( picture 23A-C) (see "Epidemiology, pathogenesis, clinical

features, and diagnosis of basal cell carcinoma")
● Atypical fibroxanthoma ( picture 24) (see "Atypical fibroxanthoma")
● Amelanotic melanoma ( picture 25A-B) (see "Melanoma: Clinical features and

diagnosis")
STAGING
At the time of diagnosis, patients with invasive cSCC should be given a full body skin
examination that includes palpation of regional lymph nodes to evaluate for additional cSCCs
and clinical signs of metastatic disease. The staging of cSCC is discussed separately. (See
"Evaluation for locoregional and distant metastases in cutaneous squamous cell and basal
cell carcinoma", section on 'Squamous cell carcinoma' and "Recognition and management of
high-risk (aggressive) cutaneous squamous cell carcinoma", section on 'Staging'.)
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Cutaneous squamous
cell carcinoma".)
SUMMARY
● Clinical presentation – Cutaneous squamous cell carcinoma (cSCC) can develop on any
surface of the skin, but sun-exposed sites are the most common locations in individuals
with lightly pigmented skin. Involvement of other areas, in particular the lower legs and
anogenital region, is more common in people with darkly pigmented skin (see
'Location' above):
• Cutaneous squamous cell carcinoma in situ – cSCC in situ (Bowen's disease)

typically presents as an erythematous, well-demarcated, scaly patch or plaque
( picture 3A-B) located in sun-exposed areas. cSCC in situ involving the penis
(erythroplasia of Queyrat) presents as a well-defined, velvety, red plaque
( picture 2D). (See 'Cutaneous squamous cell carcinoma in situ (Bowen's disease)'
above.)
• Invasive cutaneous squamous cell carcinoma – Invasive cSCC often correlates

with the level of tumor differentiation. Well-differentiated lesions usually appear as
indurated or firm, hyperkeratotic papules, plaques, or nodules of 0.5 to 1.5 cm

( picture 1A-B, 2A, 2E), although some lesions may be much larger. (See 'Invasive
cutaneous squamous cell carcinoma' above.)
• Clinical variants – Clinical variants of cSCC include keratoacanthoma ( picture 5),

verrucous carcinoma ( picture 7), squamous cell carcinoma (SCC) of the lip
( picture 9), oral SCC ( picture 2F), cSCC arising at sites of chronic inflammation
and scarring (Marjolin's ulcer), and primary lymphoepithelioma-like carcinoma of the
skin. (See 'Clinical variants' above.)
● Diagnosis – Biopsy is necessary to confirm the diagnosis of SCC. For lesions clinically
suspected to be invasive, a shave, punch, or excisional biopsy that extends at least into
the mid-reticular dermis is preferred. (See 'Biopsy and histopathology' above.)
● Staging – Patients with a confirmed diagnosis of invasive cSCC should be given a full
body skin examination that includes palpation of regional lymph nodes to evaluate for
additional cSCCs and clinical signs of metastatic disease. The staging of cSCC is
discussed separately. (See "Evaluation for locoregional and distant metastases in
cutaneous squamous cell and basal cell carcinoma", section on 'Locoregional
evaluation' and "Recognition and management of high-risk (aggressive) cutaneous
squamous cell carcinoma", section on 'Staging'.)
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Topic 16225 Version 21.0
GRAPHICS
Cutaneous squamous cell carcinoma
An erythematous, hyperkeratotic papule is present on the skin.
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights

reserved.
Graphic 60026 Version 6.0
An erythematous, scaly papule is present on the lower leg.
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights reserved.
Keratotic, cutaneous horn on an erythematous base on the preauricular

skin.
Periungual squamous cell carcinoma
An ulcerated papule is present on the periungual skin.
Squamous cell carcinoma of the tongue
This nodule on the ventral surface of the tongue is a squamous cell

carcinoma.

reserved.
Erythroplasia of Queyrat

reserved.
Bowen's disease (cutaneous squamous cell carcinoma in situ)
An erythematous, scaly, thin plaque is present on the skin.
Periungual Bowen disease (squamous cell carcinoma in

situ)
Reproduced with permission from: The Dermatology Online Atlas, www.dermis.net. Copyright
© 2012. All rights reserved.
Red papulonodule with scale on dorsal hand.
Poorly differentiated cutaneous squamous cell carcinoma
A soft, fleshy, granulomatous tumor is present on the skin.
A moist, eroded nodule on the temple.
Keratoacanthoma
Crateriform nodule with central hyperkeratosis.

reserved.
Verrucous carcinoma of the oral cavity
Verrucous carcinoma of the oral cavity.
Courtesy of Vaibhav Parekh, MD MBA.
Verrucous carcinoma of the oral cavity
Verrucous carcinoma of the oral cavity (oral florid papillomatosis).
Verrucous carcinoma (also known as giant

condyloma of Buschke-Löwenstein)

reserved.
Epithelioma cuniculatum (verrucous carcinoma)
An exophytic, eroded tumor with overlying, macerated scale-crust on the sole.
Squamous cell carcinoma on the lip
This erythematous, crusted nodule on the lip represents a

squamous cell carcinoma.

reserved.
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Oral squamous cell carcinoma
An ulcerated mass is present on the floor of the mouth.
Leukoplakia
A white plaque is present on the hard palate and gingiva.

reserved.
Dermoscopic image of nonpigmented squamous cell carcinoma in

situ (Bowen disease)
Large, coiled (glomerular) vessels in a grouped arrangement and yellow surface scales
are the dermoscopic hallmarks of nonpigmented Bowen disease.
Dermoscopic features of facial pigmented squamous cell

carcinoma in situ (Bowen disease)
Pigmented Bowen disease is sometimes characterized by small, brown dots arranged in

radial lines at the periphery of the lesion.
Dermoscopic image of facial invasive squamous cell carcinoma
On dermoscopy, white circles surrounding a yellow clod over a white background are a
clue for invasive squamous cell carcinoma.
Actinic keratosis
Actinic keratosis. Scale overlies erythematous macules.

reserved.
Bowenoid papulosis
Multiple reddish, small papules on the penis of this patient with

Bowenoid papulosis.

reserved.
Nummular eczema
A plaque of nummular eczema with erythema, vesiculation, and crusting.
Plaque psoriasis
An erythematous plaque with coarse scale is present on the knee of

this patient with psoriasis.

reserved.
Inflamed seborrheic keratosis
A stuck-on, pink plaque with overlying hemorrhagic crust.

reserved.
Prurigo nodularis
A close-up of a pink, crusted nodule.
Prurigo nodularis
A close-up of a pink, excoriated papule with a dark brown rim.
Pyoderma gangrenosum
This purulent ulcer with a ragged and violaceous border is

consistent with pyoderma gangrenosum.

reserved.
Pyoderma gangrenosum
This purulent ulcer with a ragged and violaceous border is

consistent with pyoderma gangrenosum.

reserved.
Venous stasis ulcer
Large ulcer on the malleolar region. The ulcer bed is filled with a bright red
granulation tissue and yellow fibrin exudate.
Merkel cell carcinoma
This blue-red, dome-shaped papule on the forehead is a Merkel cell

carcinoma.

reserved.
Merkel cell carcinoma
This blue-red, dome-shaped nodule is a Merkel cell carcinoma.

reserved.
Superficial basal cell carcinoma
This erythematous, slightly scaly patch is representative of a

superficial basal cell carcinoma.

reserved.
Nodular basal cell carcinoma
This pearly papule with telangiectasias is representative of a nodular

basal cell carcinoma.

reserved.
Destructive basal cell carcinoma
Large basal cell carcinoma causing destruction of the nose.

reserved.
Atypical fibroxanthoma
An erythematous, dome-shaped papule is present on the face.
Amelanotic melanoma
Amelanotic melanoma presenting as a red, excoriated, papular

lesion.

reserved.
Amelanotic melanoma
Amelanotic melanoma presenting as a red, nonspecific lesion with

slightly elevated borders.

reserved.
Contributor Disclosures
Jean Lee Lim, MD No relevant financial relationship(s) with ineligible companies to disclose. Maryam
Asgari, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Robert S
Stern, MD Consultant/Advisory Boards: Amgen [Skin reactions, migraine];Padagis[Psoriasis];Vertex
Pharmaceuticals [Skin reactions, cystic fibrosis]. All of the relevant financial relationships listed have been
mitigated. June K Robinson, MD No relevant financial relationship(s) with ineligible companies to
disclose. Rosamaria Corona, MD, DSc No relevant financial relationship(s) with ineligible companies to
disclose.
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Cutaneous Squamous Cell Carcinoma (CSCC) : Clinical Features and Diagnosis - UpToDate

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Cutaneous Squamous Cell Carcinoma (CSCC) : Clinical Features and Diagnosis - UpToDate

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Cutaneous squamous cell carcinoma (cSCC): Clinical features and diagnosis - UpToDate 1/03/23, 6:27 p.m.

Official reprint from UpToDate®

Cutaneous squamous cell carcinoma (cSCC): Clinical

● (See "Cutaneous squamous cell carcinoma: Epidemiology and risk factors".)

carcinomas not amenable to local therapies".)

Cutaneous squamous cell carcinoma in situ (Bowen's disease) — cSCC in situ (Bowen's

Invasive cutaneous squamous cell carcinoma — The clinical appearance of invasive cSCC

In contrast, poorly differentiated lesions are usually fleshy, granulomatous papules or

Keratoacanthoma — Keratoacanthomas are keratocytic epithelial tumors that clinically and

Verrucous carcinoma — Verrucous carcinoma is a rare variant of cSCC that presents with

● Anogenital (also known as giant condyloma acuminatum of Buschke-Löwenstein)

● Epithelioma cuniculatum – Verrucous carcinoma on the plantar foot ( picture 8)

Verrucous carcinoma may also occur in other locations.

Oral squamous cell carcinoma — Oral SCC usually presents as an ulcer, nodule, or

granulation tissue, rapid increase in size, and bleeding on touch.

Lymphoepithelioma-like carcinoma of the skin — Primary lymphoepithelioma-like

Dermoscopy — On dermoscopic examination, cSCC in situ (Bowen's disease) displays dotted

Biopsy and histopathology — Shave, punch, or excisional biopsies may be used for

Cutaneous squamous cell carcinoma in situ — cSCC in situ (Bowen's disease) is diagnosed

Invasive cutaneous squamous cell carcinoma — Invasive cSCCs have dysplastic

Actinic keratoses — The most common clinical diagnostic dilemma involves actinic

Bowenoid papulosis — Bowenoid papulosis is a premalignant focal epidermal dysplasia

The rate of malignant transformation of bowenoid papulosis to SCC is low (estimated to be 1

Inflammatory skin disorders — The well-demarcated, scaling, pink plaques of cSCC in situ

● Nummular eczema ( picture 16) (see "Nummular eczema")

● Psoriasis ( picture 17) (see "Psoriasis: Epidemiology, clinical manifestations, and

● Prurigo nodularis ( picture 19A-B) (see "Prurigo nodularis")

● Pyoderma gangrenosum ( picture 20A-B) (see "Pyoderma gangrenosum:

● Basal cell carcinoma ( picture 23A-C) (see "Epidemiology, pathogenesis, clinical

● Atypical fibroxanthoma ( picture 24) (see "Atypical fibroxanthoma")

● Amelanotic melanoma ( picture 25A-B) (see "Melanoma: Clinical features and

SOCIETY GUIDELINE LINKS

• Cutaneous squamous cell carcinoma in situ – cSCC in situ (Bowen's disease)

• Invasive cutaneous squamous cell carcinoma – Invasive cSCC often correlates

indurated or firm, hyperkeratotic papules, plaques, or nodules of 0.5 to 1.5 cm

• Clinical variants – Clinical variants of cSCC include keratoacanthoma ( picture 5),

Use of UpToDate is subject to the Terms of Use.

1. Waldman A, Schmults C. Cutaneous Squamous Cell Carcinoma. Hematol Oncol Clin

27. Auerbach A, Mulvaney P, Goldberg D, et al. Single-Cell Squamous Carcinoma: An

33. Gross G, Hagedorn M, Ikenberg H, et al. Bowenoid papulosis. Presence of human

34. Shabbir M, Minhas S, Muneer A. Diagnosis and management of premalignant penile

Cutaneous squamous cell carcinoma

An erythematous, hyperkeratotic papule is present on the skin.

Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights

Graphic 60026 Version 6.0

Cutaneous squamous cell carcinoma

An erythematous, scaly papule is present on the lower leg.

Graphic 52178 Version 5.0

Cutaneous squamous cell carcinoma

Keratotic, cutaneous horn on an erythematous base on the preauricular

Graphic 74240 Version 6.0

Periungual squamous cell carcinoma

An ulcerated papule is present on the periungual skin.

Graphic 65527 Version 5.0

Squamous cell carcinoma of the tongue

This nodule on the ventral surface of the tongue is a squamous cell

Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights

Graphic 81810 Version 5.0

Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights

Graphic 66886 Version 5.0

Bowen's disease (cutaneous squamous cell carcinoma in situ)

An erythematous, scaly, thin plaque is present on the skin.

Graphic 82358 Version 7.0