Management of cutaneous squamous cell carcinoma - could we do better?

Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer and it is increasing in incidence worldwide. As with its much more common ‘cousin’, basal cell carcinoma (BCC), tumours arise in keratinocytes, so both cancers are often lumped together as ‘non-melanoma’ or ‘keratinocytic’ skin cancer. However, it is desirable to distinguish the two types clinically to facilitate optimum management, as their biological behaviour may differ. Most cSCCs are classified as carrying ‘low or no risk’ of metastatic disease,but a small subgroup of patients are at ‘high risk’ and deaths do occur. The overall rate of metastasis is less than 5%, but the five-year survival is poor in the subset of patients who do develop distant metastases. In the majority of cases, patients with cSCC initially present to their GP. Knowledge of the clinical features and high-risk characteristics of cSCC is, therefore, invaluable for GPs, who have an important role to play in detecting these sometimes difficult to diagnose tumours, and in referring patients for appropriate and timely management.