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Metastatic Squamous Cell Carcinoma of Skin

Last updated Nov. 23, 2018

Approved by: Maulik P. Purohit MD, MPH

DoveMed.com

Microscopic pathology image showing invasive Squamous Cell Carcinoma of Skin.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Metastatic Cutaneous SCC
  • Metastatic Dermal Squamous Cell Carcinoma
  • Metastatic SCC of Skin

What is Metastatic Squamous Cell Carcinoma of Skin? (Definition/Background Information)

  • Metastatic Squamous Cell Carcinoma of Skin is the advanced form of squamous cell carcinoma (SCC) of skin; a common malignant skin tumor that typically affects elderly men and women. In this condition, the skin cancer has already metastasized to the lymph nodes and various parts of the body
  • Prolonged exposure to the sun’s ultraviolet rays may result in damage of skin DNA, causing squamous cell carcinoma. Other factors that may influence its development include skin tanning, radiation treatment for other reasons, previous burn injuries, and exposure to coal tar and arsenic
  • Squamous cell carcinoma of skin may appear as slow-growing skin lesions, commonly on the sun-exposed areas, such as the face, neck, hands, and even the chest. The lesions may ulcerate and cause scarring of skin
  • The treatment may include surgical procedures followed by radiation therapy or chemotherapy, as decided by the healthcare provider. Targeted therapy medications may also be used to destroy the tumor cells
  • The prognosis of Metastatic Squamous Cell Carcinoma of Skin depends upon many factors including the health status of the affected individual; it is generally guarded

Who gets Metastatic Squamous Cell Carcinoma of Skin? (Age and Sex Distribution)

  • Metastatic Squamous Cell Carcinoma of Skin is generally uncommon and it affects elderly or older adults; some cases rarely develop in children too
  • It can occur in both males and females
  • The condition is prevalent worldwide, though dark-skinned individuals (Asians and Africans) are affected less than lighter-skinned individuals (Europeans and Americans)

What are the Risk Factors for Metastatic Squamous Cell Carcinoma of Skin? (Predisposing Factors)

Metastatic Squamous Cell Carcinoma of Skin is the advanced form of SCC of skin. The chief contributing factors for squamous cell carcinoma of skin include:

  • Exposure to intense sun for long periods during the course of work or due to regular participation in outdoor sports activities
  • Frequent use of tanning beds, tanning parlors
  • People living in geographical regions where hot-dry, desert-like climatic conditions prevail
  • Radiation therapy
  • Previous burn sites
  • Arsenic exposure
  • Coal tar exposure
  • Smoking, tobacco chewing
  • Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
  • Those with sensitive skin, who get easily sunburned
  • Caucasians are more vulnerable compared to other darker-toned individuals

SCC of skin in certain locations has higher chances of metastasis and they include:

  • On the lips
  • On the penile skin
  • In the region of radiation scar
  • In the region of scar due to burns
  • Vulvar skin
  • Perianal skin

The following subtypes are the more aggressive forms of SCC of skin, and hence, there is a greater possibility of metastasis:

  • Acantholytic squamous cell carcinoma of skin
  • Spindle cell squamous cell carcinoma of skin
  • Pseudovascular squamous cell carcinoma of skin
  • Adenosquamous carcinoma of skin

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Metastatic Squamous Cell Carcinoma of Skin? (Etiology)

Metastatic Squamous Cell Carcinoma of Skin is caused by the delayed diagnosis and/or appropriate early treatment of squamous cell carcinoma of skin. Some forms of cutaneous squamous cell carcinomas are more aggressive than other forms, and these are more prone to metastasis.

  • SCC of skin develops when skin cells (the keratinocytes that form the epidermis) are burnt or damaged from prolonged (frequently severe) exposure to the ultraviolet component of the sun, over many decades
  • The source of UV may be from lamps and other such devices, apart from the sun, and their effect on the skin may cumulatively add-up
  • Sometimes, individuals working in certain industries may be exposed to chemicals or x-rays for a long duration. This may also contribute to the formation of the skin cancer
  • Scientific research has indicated that the human papillomavirus along with other risk factors, such as sun-exposure, skin color, and an advancing age, seem to greatly multiply the chance of an individual being affected by SCC of Skin. Nevertheless, the reason behind how the virus is responsible for influencing the condition’s development is not well-established

What are the Signs and Symptoms of Metastatic Squamous Cell Carcinoma of Skin?

The signs and symptoms of Metastatic Squamous Cell Carcinoma of Skin include:

  • There may be a primary skin lesion and secondary metastasized tumors at other locations of the body (usually the lymph nodes)
  • The signs and symptoms of the condition may depend upon the affected organ or body part (region of metastasis)
  • The skin lesions may appear as crusted ulcer, plaques, and nodules
  • It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
  • These lesions or tumors are common in sun-exposed areas (such as face, neck, and chest), but can appear in non-sun exposed areas too
  • The size of the lesions are frequently over 2 cm
  • In some cases, the squamous cell carcinoma may appear more pigmented than surrounding skin
  • Individuals with immunocompromised states have more aggressive tumors

How is Metastatic Squamous Cell Carcinoma of Skin Diagnosed?

A diagnosis of Squamous Cell Carcinoma of Skin is made by:

  • Complete physical examination with detailed medical history evaluation
  • Examination by a dermatologist using a dermoscopy, a special device to examine the skin
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Radiological studies that may include:
    • Plain x-ray of the affected region
    • CT or CAT scan of the affected region with contrast usually shows a mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
    • MRI scans of the affected region: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
    • Ultrasound scan of the affected region
    • MRI scans and PET scans may help detect areas of metastasis

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.

Tissue biopsy:

  • A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

In case of Metastatic SCC, the following diagnostic procedures can be used to procure the tissue sample:

  • Fine needle aspiration (FNA) biopsy of the lymph node (if metastasis is to the lymph node)
  • Core biopsy or open biopsy of the tumor

Note: Generally, an open biopsy of the tumor is not preferred and is avoided, because medical evidence has shown that doing an open biopsy on a metastatic carcinoma to the lymph node can spill the cancer out of the lymph node and make the condition worse. Hence, in many cases, surgical dissection of the affected lymph nodes or radiation therapy is preferred. 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Metastatic Squamous Cell Carcinoma of Skin?

The possible complications due to Metastatic Squamous Cell Carcinoma of Skin could be:

  • The metastasis can occur to any part of the body
  • Large lesions may ulcerate and bleed resulting in superimposed bacterial or fungal infections
  • Tumors that invade into nerves (perineurial invasion) have higher chances of recurrence and metastasis
  • Severely infiltrated or metastasized tumors may affect many body functions, depending on their location

How is Metastatic Squamous Cell Carcinoma of Skin Treated?

The treatment measures for Metastatic Squamous Cell Carcinoma of Skin may include:

  • A combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor(s)
  • Targeted therapy medications are generally used for locally infiltrated or metastatic SCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
  • Radiotherapy can be used as primary therapy in situations where the tumor cannot be removed completely, or when the tumor reappears after surgery
  • Radiotherapy can also be used as additional therapy after surgery, if there is a possibility of tumor recurrence after surgery, or if there are inadequate margins (possibility of tumor left behind) following surgery. In some cases due to location of tumor, a complete surgical removal of the tumor is difficult
  • Chemotherapy can be used for treating metastatic cases (that have spread to distant parts of the body) in the following conditions:
    • When the tumors cannot be removed completely (due to incomplete surgical resection)
    • Tumors that recur after surgery
  • Large tumors after complete skin excision may need skin grafting
  • Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important and encouraged

How can Metastatic Squamous Cell Carcinoma of Skin be Prevented?

Metastatic Squamous Cell Carcinoma of Skin develops from SCC of skin due to delayed diagnosis and/or treatment. It can be prevented if squamous cell carcinoma of skin is detected early and treated appropriately.

Additionally, the following measures may be considered in the prevention of SCC of skin:

  • Avoid prolonged and chronic exposure to the sun. If this is unavoidable (like due to an occupational requirement), then take safety steps to reduce exposure to the UV rays, by using sunscreens with high sun-protection factor, using wide-brimmed hats, and protective clothing
  • Be aware of the hazards of prolonged sun exposure and take steps to protect yourself. Plan and modify your work tasks to stay out of the sun during the period, when it is the most intense
  • Avoid excessive sunbathing (particularly if you are fair-skinned), use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
  • Individuals who are regularly exposed to the sun or work under the sun should get their skin periodically examined by a physician. This is crucial if they suspect or notice any skin changes

Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory. Often several years of active vigilance is necessary.

What is the Prognosis of Metastatic Squamous Cell Carcinoma of Skin? (Outcomes/Resolutions)

  • The prognosis of Metastatic Squamous Cell Carcinoma of Skin is generally guarded or unpredictable
  • The prognosis may further depends upon the following set of factors:
    • Stage of tumor: In higher-stage tumors, such as tumors with metastasis, the prognosis is typically poor
    • The subtype of squamous cell carcinoma of skin (certain subtypes are more aggressive than others)
    • The site of metastasis: Metastasis to the local lymph nodes do better than the spread of cancer to distant sites (such as to the lung or brain)
    • The surgical resectability of the tumor (meaning, if the tumor can be removed completely) 
    • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
    • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
    • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer prognosis compared to tumors that do not recur
    • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment

If Metastatic SCC of Skin occurs in the following group of individuals, the prognosis is worse to poor:

  • Individuals who have undergone an organ transplant
  • Individuals who are chronically alcoholic
  • Those with genetic disorders such as xeroderma pigmentosa

Additional and Relevant Useful Information for Metastatic Squamous Cell Carcinoma of Skin:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/cancer/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Dec. 16, 2015
Last updated: Nov. 23, 2018