"Ultrasound "
"MRI "
"excise low-risk tumours with 4–6 mm margins; use Mohs surgery for high-risk areas (face, ears) or recurrent tumours 9"
"Histologically, it is characterised by nests, sheets, or cords of atypical squamous cells invading the dermis. Tumour cells exhibit eosinophilic cytoplasm, enlarged hyperchromatic nuclei, and intercellular bridges. Keratin pearls and individual cell keratinisation are hallmark features 4. Poorly differentiated cSCC shows minimal keratinisation and marked nuclear pleomorphism. The tumour often originates in sun-damaged skin, evidenced by adjacent solar elastosis. Actinic keratosis or Bowen's disease may be present as precursor lesions 4,5. Perineural invasion, when present, indicates aggressive behaviour. Tumour depth (>6 mm) and poor differentiation are important prognostic factors 6."
"positive: CK5/6, p40, p63 (squamous differentiation markers)"
"negative: BerEP4 (helps distinguish from basal cell carcinoma)"
"p16: often lost in UV-related cSCC (unlike Human Papillomavirus (HPV)-positive head and neck SCC)"
"p16: often lost in UV-related cSCC (unlike Human Papillomavirus (HPV)-positive head and neck SCC)"
"start immunotherapy (cemiplimab/pembrolizumab) for metastatic/unresectable cSCC; reserve chemotherapy (cisplatin/5-FU) for refractory cases"
"High-risk features:"
Expected headings
"Radiologic features"
"Ultrasound "
"CT"
"MRI "
"PET-CT"
"gold standard: skin biopsy (shave, punch or excisional) with histopathology 3"
"advanced/locally invasive: loss of normal tissue planes, possible perineural, cartilage or bone involvement"
"perineural spread: nerve thickening and enhancement (e.g. facial nerve branches)"
"immunosuppression (e.g. transplant patients)"
"survival rates are generally lower for immunosuppressed patients (e.g. transplant recipients)"
"excise low-risk tumours with 4–6 mm margins; use Mohs surgery for high-risk areas (face, ears) or recurrent tumours 9"
"start immunotherapy (cemiplimab/pembrolizumab) for metastatic/unresectable cSCC; reserve chemotherapy (cisplatin/5-FU) for refractory cases"
"melanoma: more likely to metastasise; may have similar nodal involvement"