What is included in the management of precancerous skin lesions and cutaneous squamous cell carcinoma (cSCC)?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Many patients with light skin and a history of extensive sun exposure develop epidermal atypia in the form of actinic keratosis and SCCIS over large areas of their skin. Most of these patients also develop multiple invasive cSCCs. The management of such patients is highly labor intensive and involves the following steps:

  • Surgically remove all tumors that clinically appear to have to have an invasive (dermal) component and confirm clearance of histologic margins

  • Evaluate for underlying immunosuppression, such as from chronic lymphocytic leukemia or from overimpairment of the immune system by immunosuppressive or immunomodulatory therapy; if this last is suspected, discuss with the patient’s other doctors whether the immunosuppression can be safely remedied or lessened

  • Perform field treatment of the areas of epidermal atypia

  • Follow the patient closely for recurrence of actinic keratosis/SCCIS and for new invasive SCCs; field treatment may need to be repeated every 6-12 months to keep precursor actinic keratosis and SCCIS lesions to a minimum


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