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Clinical Summary

Squamous cell carcinoma (SCC) is the 2nd most common skin cancer. It is associated with a higher incidence in males, increased age, chronic sun exposure, immunosuppressive treatment, and chronic burns or scars. Initially, SCC presents with erythematous macules that develop into firm papules and plaques. Most are located on the sun-exposed sites of the head, neck, and upper extremities, but can occur anywhere.

Management and Disposition

After ensuring a secondary infection is not present, prompt outpatient dermatologic referral is indicated.

FIGURE 13.62

Squamous Cell Carcinoma. The lower lip is exposed to more sunlight and involved more frequently. (Photo contributor: J. Matthew Hardin, MD.)

FIGURE 13.63

Squamous Cell Carcinoma. This nodule with central ulceration slowly developed over 1 year. (Photo contributor: J. Matthew Hardin, MD.)


  1. There is a higher risk of metastasis with SCC versus basal cell carcinoma (although still very low). As with basal cell carcinoma, metastatic potential is higher on the ears, periocular area, nose, and lips; do not miss the opportunity to refer patients with questionable lesions.

  2. Any persistent nodule, plaque, or ulcer should be referred to dermatology for potential SCC.

FIGURE 13.64

Squamous Cell Carcinoma. This nodule has a central keratogenous core. (Photo contributor: J. Matthew Hardin, MD.)

FIGURE 13.65

Squamous Cell Carcinoma. Ulcerated nodule on the forehead. (Photo contributor: J. Matthew Hardin, MD.)

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