Squamous Cell Carcinoma

Image and content excerpted from the VisualDx clinical decision support system.

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ICD-9 Codes

173.92 – Squamous cell carcinoma of skin, site unspecified

Synopsis

Squamous cell carcinoma (SCC), a malignancy of epidermal skin cells, occurs most frequently on sun-exposed areas such as the face, arms and hands, but also mucosal surfaces. SCC tends to be much more frequent and aggressive in the immunocompromised patient. These malignant tumors are prevalent in organ transplant recipients and those with HIV/AIDS. Patients with AIDS have a 3–5 times increased risk of SCC; even with antiretroviral therapy, the risk in HIV-infected patients is still 1.5–2 times that of the general population. Risk for SCC directly correlates to the length and degree of the immunosuppressive regimen. Azathioprine and cyclosporin use appears to present higher risk than other immunosuppressive agents. Other risk factors for developing SCC include increased lifetime UV exposure, increased age, a light skin type, blue eyes, personal or family history of skin cancer or actinic keratoses, and prior HPV infection. Heart transplant patients are at greatest risk, followed by renal patients, and finally liver transplant recipients. In one prospective study, the annual incidence of SCC in renal transplant patients was 3.5%, with increasing incidence with longer duration of immunosuppression.

Penile or anal SCC is seen more frequently in patients with HIV/AIDS. Risk of anal SCC is at least two-fold greater in HIV-infected individuals. These tumors often develop within longstanding condyloma acuminata. Mucosal papillary tumors or flat lesions are seen, and symptoms may include pain, itching, burning, and/or bleeding. Over time, the lesions slowly progress into a tumorous mass or slowly infiltrate into deeper tissue.

In the HIV-infected patient, one must consider the possibility of anal intraepithelial neoplasia (AIN), which is a corollary to cervical intraepithelial neoplasia. HIV-infected patients should undergo routine screening for possible AIN and anal SCC.

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