Squamous Cell Carcinoma or Actinic or Solar Keratosis

Actinic or solar keratoses are red, scaly, tender patches usually on the face, scalp, tops of the ears, back of the hands and arms that are in fact pre-cancerous (see figure IV) . These very common lesions do eventuate or can eventuate into squamous cell carcinoma, but at a fairly low rate, estimated to be less than 1% per year. Thus a patient with one hundred solar keratoses may develop one squamous cell carcinoma per year. Without question, patients with multiple solar keratoses usually have a high risk of developing skin cancer; in fact, all types of skin cancer including basal cell carcinoma and melanoma. These patients need to be treated for these pre-cancerous solar keratoses and monitored very carefully for the development of serious cancers. On the other hand, pre-cancerous solar keratoses do not usually need to be excised or treated aggressively. They can be managed by the patient with self-applied creams or treated with simple minor procedures in the dermatologist's office. Some pathologists now call all solar keratoses squamous cell carcinoma and grade them as to severity. This is unfair to the patient resulting in aggressive surgery for lesions that for over one hundred years have been treated with simple outpatient procedures by dermatologists, such as freezing with liquid nitrogen, or scraping them off with a curette or treating them with creams like 5-flurouricil and imiquimod. The dermatopathologist's subjectivity in interpretation of solar keratosis versus squamous cell carcinoma is another problem similar to that mentioned above for melanoma, but much, much more common.

Solar keratoses are very common and when they become thick, painful, or start to bleed, they are frequently appropriately biopsied by dermatologists to rule out squamous cell carcinoma. Most of them, in fact, are not squamous cell carcinoma and the interpretation should be definitive enough to avoid unnecessary surgery, but unfortunately for patients, that is not always the case.

There have been many cases that have been referred for surgery, including aggressive surgery on the nose or ears as squamous cell carcinoma when, in fact, re-interpretation of the slides by Dr. Geisse showed solar keratosis resulting in a minor procedure compared to what the patient had been referred for.

Anytime you have been diagnosed with squamous cell carcinoma, it would be appropriate to have the biopsy re-reviewed to make sure you if you have been given the correct diagnosis and thus are obtaining the proper treatment.