Unusual Cutaneous Squamous Cell Involving Distal Extremities
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Unusual Clinical Presentations of Cutaneous Squamous Cell Involving Distal Extremities in Four Patients

The Importance of Tissue Sampling

Scott Jaros, BS; Paul Googe, MD; Carolyn Ziemer, MD, MPH; and Jayson Miedema, MD

Disclosures

Wounds. 2023;35(5):E149-E153. 

In This Article

Abstract and Introduction

Abstract

Introduction: cSCC is the second most common cutaneous malignancy worldwide behind basal cell carcinoma. Typically, SCC is diagnosed early before it infiltrates local subcutaneous tissue or metastasizes. However, unusual presentations are possible and can lead to delayed treatment and possibly worse outcomes.

Materials and Methods: All patients were White of non-Hispanic or Latino decent. Three-quarters of the cases were male, and a quarter female. The age range was 45 to 78 years. The documented sizes of lesions ranged from 6 cm to 10 cm in diameter. Three of the cases were initially diagnosed as nonhealing wounds, and one was diagnosed as cellulitis.

Results: The authors observed that SCC can present unusually by mimicking nonhealing infected ulcers or skin infections such as cellulitis. Over 18 months, the authors' practice recorded 4 cases of cSCC that were initially treated as persistent infections, which potentially lead to worse outcomes.

Conclusion: These cases provide patterns and clues to potentially expedite the diagnosis and treatment of cSCC. Any skin lesion thought to be infectious but not responding to treatment should undergo tissue sampling.

Introduction

cSCC originates from the keratinocyte in the epidermis, where it may spread superficially or begin to infiltrate the dermis and beyond.

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