For a 10mm moderately to poorly differentiated squamous cell carcinoma (SCC) of the antihelix, the management plan involves urgent referral to a specialist, typically a dermatologist or head and neck surgeon, via a 2-week suspected cancer pathway for prompt assessment and diagnosis.
Initial steps include a biopsy to confirm diagnosis, followed by imaging such as ultrasound and possibly CT or MRI to assess local invasion and regional lymph node involvement for staging purposes.
The primary treatment is wide local excision of the lesion with clear margins to reduce recurrence risk. Given the moderate to poor differentiation and size (10mm), sentinel lymph node biopsy or sampling may be considered to evaluate for occult metastases.
Depending on surgical margins and pathological staging, adjuvant radiotherapy may be recommended to improve local control, especially if there is perineural invasion, lymphovascular invasion, or positive lymph nodes.
Follow-up should be structured and risk-adapted, typically involving regular clinical reviews to detect recurrence or new primary lesions, with patient education on symptoms of recurrence.
The recommended timeline is urgent referral within 2 weeks of suspicion, biopsy and imaging within days to weeks, surgery planned promptly after staging (usually within 4 weeks), and initiation of adjuvant therapy within 6-8 weeks post-surgery if indicated. Follow-up visits are usually scheduled every 3-6 months for the first 2 years, then less frequently thereafter.