Dermatology

Cutaneous Squamous Cell Carcinoma

Second most common skin cancer arising from keratinocytes on sun-exposed skin; higher metastatic risk than BCC, especially on lip, ear and in immunosuppressed patients.

Last reviewed 20 Jul 2026 - MedicoMedics editorial team

Skin cross-section showing squamous cell carcinoma

Pathophysiology

Cumulative UV damage (TP53 mutations), immunosuppression (transplant), HPV, chronic wounds/burns (Marjolin ulcer).

Sources: NCCN SCC 2024; Cemiplimab (NEJM 2018;379:341)

Presentation

Scaly, hyperkeratotic or ulcerated plaque on sun-exposed skin; actinic keratosis precursor; may bleed easily.

Diagnosis

Shave or punch biopsy; TNM staging based on tumour size, depth, perineural invasion; high-risk features (>2 cm, >6 mm depth, perineural, immunosuppression).

Management

Low-risk: excision with 4-6 mm margins or electrodesiccation. High-risk facial: Mohs. Locally advanced/metastatic: cemiplimab (anti-PD-1); radiotherapy adjuvant.

Sample USMLE-style MCQs

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Question 1

A transplant recipient has a rapidly enlarging keratotic nodule on the lip. Diagnosis?

Question 2

Which agent is FDA-approved for advanced cutaneous SCC?

Question 3

Best surgery for high-risk facial SCC?

Question 4

Chronic scar SCC eponym?

Question 5

Precursor lesion to SCC?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 20 Jul 2026 by MedicoMedics editorial team.

Frequently asked

Which pre-lesion?

Actinic keratosis.

Highest metastasis risk site?

Lip and ear.

Immunosuppressed patient risk?

65-fold increased SCC risk.

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