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SCC in Immunosuppression — RACP Adult Medicine MCQ

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ModerateGastroenterologySCC in ImmunosuppressionRACP Adult Medicine

A 68-year-old immunosuppressed renal transplant recipient presents with a rapidly growing, firm, indurated nodule with central keratinisation on his forearm. It has an elevated, rolled border with a central crater filled with keratin. What is the most likely diagnosis?

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Correct answer: A — Squamous cell carcinoma

A rapidly growing firm nodule with central keratinisation in an immunosuppressed transplant recipient is SCC (or keratoacanthoma, which is considered a well-differentiated SCC variant). Transplant recipients have 65–250× increased SCC risk. Treatment is wide local excision (≥6 mm margins). Sentinel lymph node biopsy may be considered for high-risk lesions.

Reference: Cancer Council Australia – 2024 – Non-Melanoma Skin Cancer Guidelines