Synopsis
Recognise invasive cutaneous squamous-cell carcinoma, identify clinical and pathological high-risk features, refer every suspected lesion urgently and coordinate excision, nodal assessment and prevention.
- Suspect SCC in a persistent enlarging tender indurated keratotic, crusted or ulcerated lesion, particularly on chronically sun-exposed skin.
- NICE recommends urgent suspected-cancer referral for every lesion clinically suspicious for cutaneous SCC.
- High-risk features include lip or ear site, diameter over 2 cm, depth over 6 mm or beyond subcutaneous fat, poor differentiation, perineural invasion, recurrence and immune suppression.
Key red flags
Rapid growth, severe pain, numbness, fixation, recurrent tumour, lip or ear site, diameter over 2 cm, immune suppression, palpable nodes or chronic-scar ulceration requires urgent suspected-cancer referral and high-risk staging.
Persistent keratotic ulceration on vermilion lip or pinna carries higher metastatic risk and demands urgent referral.
Investigation priorities
Confirm SCC and measure invasive and pathological risk features.
Management branches
A persistent indurated keratotic, ulcerated or rapidly growing lesion could represent invasive SCC.
- Measure and document morphology, growth, site, immune status, neurological symptoms and regional nodes.
- Make an urgent suspected-cancer referral, leaving the lesion available for appropriately deep biopsy and definitive planning.