Squamous Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerSquamous Cell CarcinomaSCE Dermatology

A 65-year-old woman presents with an ulcerated nodule on her scalp that bleeds easily. Biopsy shows an invasive poorly differentiated SCC with depth >6 mm and lymphovascular invasion. What TNM staging feature makes this a high-risk SCC?

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Correct answer: A — Tumour depth >6 mm and lymphovascular invasion

BAD guidelines identify several high-risk features for cutaneous SCC: depth >6 mm or invasion beyond subcutaneous fat, poorly differentiated histology, perineural invasion, lymphovascular invasion, immunosuppression, recurrent tumours, and location on the ear or lip. High-risk SCCs require wider excision margins or Mohs surgery, sentinel lymph node biopsy consideration, and closer follow-up. Metastatic risk for high-risk SCC is approximately 5-10% compared to 1-2% for low-risk SCC. Multidisciplinary discussion is recommended.

Reference: BAD 2020 SCC Guidelines; NICE NG12