Key Treatment

Surgical resection with 4-mm margins should remove small cell carcinoma (low risk, <2 cm) completely in 95% of patients (Motley et al., 2003) (SOR: A).

Mohs surgery (MMS) is considered first-line treatment of high-risk SCC (Motley et al., 2003) (SOR: B).

Experienced physicians can remove small (<1 cm) slow-growing SCC tumors on sun-exposed sites with curettage (Motley et al., 2003) (SOR: B).

Figure 33-85 Squamous cell carcinoma on lip. © Richard P. Usatine.)

rates can be as high as 30% to 40%. High-risk areas for metastasis include the ear, lip, genitalia, and areas of chronic inflammation (burns, scars, ulcers). A biopsy is required for diagnosis, which can be done with the shave or punch technique. Treatment of superficial SCC is covered under Bowen's disease.

Many SCCs can be excised with 4-mm to 5-mm margins. Smaller lesions may be amenable to ED&C. Several series report excellent cure rates with ED&C, and experience suggests that small (<1 cm), well-differentiated, primary slow-growing tumors arising on sun-exposed sites can be removed by experienced physicians with curettage (Motley et al., 2003). As with BCC, tumors of SCC that are large, invasive, recurrent, or near vital or cosmetically sensitive structures are best treated with Mohs surgery. Surgical resection with 4-mm margins should be adequate for well-defined low-risk tumors less than 2 cm in diameter. Such margins are expected to remove the primary tumor mass completely in 95% of cases. MMS should therefore be considered as firstline treatment of high-risk SCC, particularly at sites where wide surgical margins may be difficult to achieve without functional impairment (Motley et al., 2003). A prospective, multicenter case series of 1263 patients with SCC who

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