Non-Melanoma Skin Cancers

• Epidemiology
  • Kills about 2000 Americans annually and has a 95% cure rate. The incidence is pretty high- over 1 million cases per year (costing Medicare a whole lot of money).
  • Basal cell carcinomas are most common in light skin individuals while squamous cell carcinoma is most frequently encountered in dark skinned individuals.
     
• Basal Cell Carcinoma
  • This lesion often presents as a translucent nodule with central umbilication and border telangiectasia (small blood vessels). While aggressive (causes local destruction), it rarely metastasizes. Histologically, it is characterized by clusters of darkly staining cells with a palisade arrangement of nuclei of the cells on the tumor periphery
  • Surgically, these are removed using Mohs’ microscopic dissection, because the tumors often grow in continuity.
     
• Squamous Cell Carcinoma
  • In general, SCCs are less aggressive if derived from an actinic keratosis (basically meaning that the cancer is sun induced). These cancers can evolve from chronic scars. They may be highly malignant on the lips and may metastasize and kill.  In addition to arising from actinic keratoses, these cancers can also occur due to chemical carcinogens (i.e. arsenic used for psoriasis therapy) or from radiation exposure (i.e. chronic x-ray exposure or contaminated gold)
     

• Cutaneous Squamous Cell Carcinoma
  • Presents as an eroded papule or nodule that may have a rolled non-translucent quality. They may also appear at the site of a chronic scar and be evident as a cutaneous horn.

• Erythoplasia of Queyrat (erytholeukoplakia)
  • This is a precancerous disease of the mucous membrane of the penis, evident by a rash and irritation inside the shaft. It is typically found in uncircumcised men. The differential diagnosis often includes psoriasis, lichen planus, candidaisis and contact dermatitis.

• Penile Squamous Cell Carcinoma
  • Clinically, this cancer often presents as an eroded plaque. It is not very prevalent in the US, but around the world it makes up 20% of all male cancers. Circumcision may possibly be protective.
     
• Scrotal Squamous Cell Carcinoma
  • First describes in 1775 by Percival Pott, this carcinoma is caused by chemical irritants (arsenic or tar, possibly) that get trapped in the scrotal folds. It was most often associated with chimney boys, but was found to occur in cotton workers and mechanics too. Clinically it presents as a wart like nodule that can metastasize and kill. How to avoid getting this? Stay clean… dirtiness is sadly not next to manliness (unless you like cancers, of course)
     
• Verrucous Carcinoma
  • This cancer is an odd one. Clinically, it presents as a slow growing, warty tumor. Histologically, it shows local invasion with minimal atypia. It may possibly be associated with HPV.

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