Tumor Board Presentation

 P.F.
 81 / Female
 Widow
 Camiling, Tarlac
 Foul smelling mass, right inguinal area
 8 months prior to consult
 2 x 2 cm mass, pinkish in color, non tender, inguinal area, right
 So other associated s/sx
 No consult done

 6 months prior to consult

 Slowly increasing in size
 Started to have occasional bleeding
 Still no consult
 2 months prior to consult
 Started to have areas of necrosis
 Foul smelling
 “hid it from family”

 1 week prior to consult

 Family discovered the mass, hence consult
 Patient was seen at our OPD
 Incision biopsy was done
 Histopathology: squamous cell carcinoma
 Subsequently admitted

 * CT scan was requested and referred to our consultant

 Referred to Consultant – Plan: Wide Excision
 (+) Hypertension – controlled
 With Metoprolol 50 mg OD
 (-) DM, Asthma, Known allergies
 (-) previous surgeries
 (-) family history of cancer
 House wife
 Non alcoholic beverage drinker
 Non smoker
 General: well kempt, medium built, fair complexion, flabby skin, conscious,
coherent, not in respiratory distress
 Vital signs: BP:130/80, CR: 80, RR: 18, T: 37
 HEENT: normocephalic, grey hair, no lesions, no cervical lymphadenopathies,
no neck mass
 Cardiac: adynamic precordium, normal rate with regular rhythm
 Respiratory: symmetric chest expansion, clear breath sounds
 Abdomen: globular, normoactive bowel sounds, soft, flabby, non tender
 Genito-urinary: scanty hair, no lesions noted in the genital area, no palpable
lymph nodes
 Integumentary: 10x10 fungating mass with areas of necrosis in the right inguinal
area, no active bleeding noted, foul smelling
 CONSTITUTIONAL: No weight loss, fever, chills, weakness or fatigue.
 HEENT: No visual loss, blurred vision, double vision or yellow sclerae. Ears,
Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore
throat.
 SKIN: No rash or itching.
 CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No
palpitations or edema.
 RESPIRATORY: No shortness of breath, cough or sputum.
 GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No
abdominal pain. No changes in bowel movement
 Squamous cell Carcinoma, inguinal area, right
 Patient was referred to Internal Medicine service for Cardio-Pulmonary
Clearance
CBC FBS: 3.80 (3.9 – 6.1) Electrolytes
• Hemoglobin: 113
• Hematocrit: .31 BUN: 2.96 (2.9 – 8.2) Na: 142.8
• WBC: 13 .4
• Neutrophils: .75 Creatinine: 81.33 (53-106) K: 5.1
• Lymphocytes: .1 Cl: 109.3
• Platelets: 347,000
UA
PC: 12-15
RC: 4-6
Bacteria: moderate
Glucose: negative
Protein: negative
Protime APTT
Pt: 12.2 (12-14 sec) Pt: 30.6 (26.1 – 36.3)
Control: 12.5 (10.7-13.7) Control: 39.4 sec
% activity: 81.7 (79 –
100%)
INR: 1
ISA: 1
 There is a homogenously enhancing irregular mass seen at the right
anterior pelvic soft tissue extending to the right inguinal region
measuring 3 x 10.6 x 8.5 cm.
 Evaluation:
 Intermediate risk for developing cardiac complication intraoperatively
 Moderate risk for developing pulmonary complication post operatively
 No absolute contraindication with the contemplated procedure
 Underwent wide excision of fungating inguinal mass, right
 Patient was discharged improved
 No post operative complications noted.
Squamous Cell Carcinoma
o second most common skin cancer
o Generally afflicting individuals of lighter skin color
o Primary risk factor = UV exposure,
o other risks include chemical agents, physical agents (ionizing radiation),
psoralen and UVA (PUVA), HPV-16 and -18 infections (immunosuppression),
and smoking.
SCC has in situ variants:
o Bowen’s disease
o Erythroplasia of Queyrat (in situ lesions of the penis)
and invasive variants.
In situ disease presents as well-delineated pink papules or plaques, and
invasive disease presents as slightly pink or skin-colored, raised plaques.
Bleeding of the lesion with minimal trauma is not uncommon, and pain is
rare.
 natural history of invasive disease depends on location and inherent
tumor characteristics.
 Lesions associated with chronic inflammation and located at
mucocutaneous junctions  metastasize in 10% to 30% of cases
 Lesions arising in sun-exposed areas without adverse risk factors are less
likely to spread and have a better prognosis
 Presentation with neurologic symptoms
 immunosuppression,
 tumor with poorly defined borders,
 tumor that arises at a site of prior radiation
 Perineural involvement
 poor differentiation
 thickness greater than 4 mm
 Adenoid
 Adenosquamous
 desmoplastic subtypes
 relatively uncommon, locally aggressive, clinically exophytic, low-grade,
slow-growing, well-differentiated squamous cell carcinoma with minimal
metastatic potential
 exophytic and hyperkeratotic mass
 Human papillomavirus (HPV) infection (oral cavity, anogenital region,
plantar foot)
 Chemical carcinogenesis induced by smoking and chewing tobacco
 Alcohol consumption and betel nut chewing (oral lesions)
 Chronic inflammation
 T2 – Tumor larger than 2 cm or tumor of any size with 2 or more high-risk
features (AJCC Cancer Staging Manual)
 T3 – tumor 4 cm or larger in maximum dimension (NCCN)
 N0 – no regional lymph node metastasis
 M0 – no distant metastasis

 T3N0M0
 cautery and ablation
 cryotherapy,
 drug therapy including imiquimod
 Surgical excision
 Moh’s microsurgery
 radiation therapy
 treatment of choice, when feasible.
 < 2 cm in diameter, wide excision with a 4-mm margin for low-grade
lesions and a 6-mm margin for high-grade lesions is sufficient.
 high risk:
 size >2 cm in diameter
 involvement of subcutaneous tissue.
 VC of the oral cavity is a distinct clinical entity with good prognosis.
Surgical excision with wide margins and appropriate reconstruction yields
a good outcome.
 Oral VC (OVC) is a slow growing lesion with exophytic growth pattern and
predilection for males in fourth to sixth decade which becomes locally
invasive if not treated properly
 Betel nut chewing, poor dental hygiene, and human papillomavirus
(HPV) infection have been implicated in the development of OVC
 Verrucous carcinoma of the external genitalia and perianal region is a rare
variant of well-differentiated squamous cell carcinoma. It has been
reported to have limited metastatic potential.

 We report the case of a 54 year-old Moroccan man who presented with

locally advanced giant condyloma acuminatum

 Verrucous carcinoma (VC) was first described as a distinct well-

differentiated variety of squamous cell carcinoma (SCC) by Ackerman [1].
VC tends to appear mainly in oropharynx, genitalia and soles of the feet,
although it may occur anywhere on the skin
 Radiological investigations consisted of a thoracic-abdominal-pelvic
computed tomography scan which showed the localization of this tumor
in the external genitalia, perineal and suprapubic region without any
lymph nodes or distant metastases.

 VC is a rare, locally aggressive tumor. Surgical complete excision of VC is

advised. Other treatment modalities such as chemotherapy or
radiotherapy could be used to avoid mutilating surgical interventions.
 Thank you very much!