Squamous Cell of Head and Neck


Invasive Lesions

  • low-grade SCCA are the most common
  • high-grade SCCA are 5% of the SCCA
  • basal cell arise from the skin of the lip but not the vermilion (but may invade it)
  • melanoma

Superficial Lesions

  • CIS
  • Leukoplakia
  • Hyperkeratosis
  • Cheilitis


  • hemangiomas
  • fibromas
  • cysts

Various Forms of SCCA

Eponyme for Squamous Cell Carcinoma

Marjolin's Ulcer
SCC winthin a burn scar
Verrucous Carcinoma
Low-grade SCCA, exophytic & often anogenital, oral, or on the plantar surface foot with little metastatic potential
Spindle Cell
> 40 yo in sun exposed areas

Keratocanthoma (KA)

  • originates in the pilosebaceous glands and closely and pathologically resembles squamous cell carcinoma (SCC).
  • KA is reddish papules rapidly progress crateriform ulceration or keratin plug.
  • KA are recurrent after surgical excision or those in which resection would result in cosmetic deformity may benefit from RT 35/15fx to 56/28fx.

Carcinoma In Situ

Bowen’s disease

  • Untreated, development of invasive carcinoma is possible but uncommon.
  • Unlike actinic keratosis, Bowen’s disease involve epidermal appendages, particularly the hairfollicle.
Erythroplasia of Queyrat
is Bowen’s disease of glans penis or vulva.


  • Surgical excision is usually preferred; however, radiation therapy may be considered as an alternative.
  • 45 to 50 Gy at 2.5 to 3.5 Gy per fraction commonly employed.
  • Facial lesions require 56 Gy at 2.0 Gy per fraction for improved cosmesis.
  • Radiation therapy may be contraindicated for lower extremity lesions, as chronic, nonhealing ulcers are reported


Actinic Keratosis

  • scaly or crusty bump
  • epidermal hyperplasia and cellular atypia

Tumor Recurrence[2]

  • Recurrent SCCA occurs in 15% of patients
  • A minority of patients (27%) did not have an identifiable index lesion.
  • most recurrent lesions are located within the lymphatic drainage of the parotid:

Local Recurrence and Metastasis

Influence of Tumor Variables on Local Recurrence and Metastasis of SCCA[6],[7]

Factor Local Recurrence Metastasis Comments
Size size alone is not likely to be an independent factor for metastasis
2 cm 7.4% 9.1%
≥ 2 cm 15.2% 30.3%
Thickness/ Depth of invasion > 4-5 mm likely to have high-rate (> 15%) of regional LN
< 4 mm 5.3% 6.7%
> 4 mm 17.2% 45.7%
Differentiation associated with regional metastases
Well Differentiated 13.6% 9.2%
Poorly Differentiated (desmoplastic SCCA) 28.6% 32.9%
Sun-exposed 7.9% 5.2%
Ear 18.7% 11.0% high risk especially with cartilage invasion, deep invasion or poor differentiation
Lip high-risk especially T3/T4
Scar Carcinoma N/A 37.9%
Previous Treatment 23.3% 30.3% higher incidence of nodal metastasis
Perineural Involvement 47.2% 47.3% ENI recommended
Immunosupression N/A 12.9%
1. O’Brien CJ. The parotid gland as a metastatic basin for cutaneous cancer. Arch Otolaryngol Head Neck Surg. 2005; 131:551-555.
2. Veness MJ, Palme CE, Morgan GJ. High-risk cutaneous squamous cell carcinoma of the head and neck: results from 266 treated patients with metastatic lymph node disease. Cancer. 2006 Jun 1;106(11):2389-96. PMID: 16649220
3. Chen AM, Grekin RC, Garcia J, Bucci MK, Margolis LW.Radiation therapy for cutaneous squamous cell carcinoma involving the parotid area lymph nodes: dose and volume considerations.Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1377-80.
4. Wallace A, Morris CG, Kirwan J, Amdur RJ, Werning JW, Mendenhall WM. Radiotherapy for squamous cell carcinoma of the nasal vestibule.Am J Clin Oncol. 2007 Dec;30(6):612-6.
5. Moore BA, Weber RS, Prieto V, El-Naggar A, Holsinger FC, Zhou X, Lee JJ, Lippman S, Clayman GL. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. Laryngoscope. 2005. Sep;115(9):1561-7.
6. Thomas Habif, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 1996.
7. Rowe DE, Carroll RJ, Day CL: J Am Acad Dermatol 26:976-990, 1992.
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