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Squamous Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerSquamous Cell CarcinomaSCE Dermatology

A 65-year-old man with a history of actinic keratoses on his scalp presents with a rapidly growing 2.5 cm keratinising nodule on his bald scalp. Biopsy confirms well-differentiated squamous cell carcinoma with perineural invasion. What is the recommended surgical approach?

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Correct answer: A — Mohs micrographic surgery

Perineural invasion is a high-risk feature in cutaneous SCC. BAD guidelines recommend Mohs micrographic surgery or excision with complete circumferential peripheral and deep margin assessment for high-risk SCCs. High-risk features include perineural invasion, size >2 cm, poorly differentiated histology, location in high-risk sites, and immunosuppression. Standard 4 mm margins would be insufficient for a high-risk tumour with perineural invasion. Curettage and cryotherapy are inappropriate for high-risk SCC.

Reference: BAD 2020 Multiprofessional guidelines for management of SCC