Large Squamous Carcinoma

This post is an answer to the Case – Lump Above Right Buttock

What would you expect to find on further examination, and where would you examine for evidence of possible metastatic disease?

Sure enough, palpation revealed that the lump was rubbery-hard in consistency, with raised, everted edges. The groins were carefully palpated and enlarged, rubbery hard nodes were felt on the right side. The rest of the clinical examination found an otherwise perfectly healthy – but very anxious – woman.

This is a relatively unusual site for this tumour. Where is it more often found?

Squamous carcinoma of the skin usually occurs at sites exposed to sunlight – the face and the backs of the hands.

What are the predisposing factors for the development of this tumour?

Predisposing factors to the development of squamous carcinoma of the skin include, as already mentioned, exposure of white skin to sunshine or to irradiation, exposure to carcinogens (e.g. pitch, tar and soot, malignant change in senile keratosis, lupus vulgaris and chronic ulcers (Marjolin’s ulcer*), malignant change in Bowen’s disease† (carcinoma in situ) and in patients on long-term immunosuppressive drugs.

Left untreated, what causes death in these patients?

Blood-borne metastases are unusual in this condition. Death occurs from repeated haemorrhages and infection of the mass, when it eventually and inevitably ulcerates, or haemorrhage from ulceration of the involved lymph nodes infiltrating the groin vessels.

How was this patient treated?

The diagnosis was first confirmed by taking a biopsy under local anaesthetic from the tumour edge. This revealed the typical appearances of a moderately well differentiated squamous carcinoma of the skin