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Cutaneous squamous cell carcinoma - Anogenital in
See also in: Overview,Hair and Scalp,Nail and Distal Digit
Other Resources UpToDate PubMed

Cutaneous squamous cell carcinoma - Anogenital in

See also in: Overview,Hair and Scalp,Nail and Distal Digit
Contributors: MacKenzie Griffith, Casey P. Schukow DO, Gaurav Singh MD, MPH, Belinda Tan MD, PhD, Sarah Hocker DO, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Squamous cell carcinoma (SCC) is a keratinocyte-derived carcinoma that occurs most frequently on sun-exposed areas such as the face and hands. However, SCC may also occur on the male genitalia, where it typically presents in later decades of life. Penile cancer, of which SCC comprises a majority, is a rare entity in the United States. Penile SCC is far more common in developing countries, where it represents up to 10% of cancers in men. The incidence of anal SCC has increased for men in recent decades, too, likely due to growing case numbers in high-risk patients (eg, men who have sex with men, immunosuppressed individuals, HIV-infected individuals).

The clinical presentation is variable. SCC often presents as a hyperkeratotic papule or nodule that may ulcerate, but it may also be smooth, plaque-like, exophytic, or papillomatous. Lesions are often red to skin colored. Secondary changes such as scale, crust, erosion, and ulceration can be present. The progression of lesions over time varies. Some enlarge slowly, while others progress rapidly to grow, infiltrate deeper tissue, and metastasize. Pain and tenderness can be present. Anal carcinomas may also present with rectal bleeding and a sensation of an object in the rectum.

The pathogenesis of SCC is multifactorial. It may evolve from intraepithelial neoplasia (including penile intraepithelial neoplasia or anal intraepithelial neoplasia) or arise de novo. TP53 and NOTCH1 gene mutations have been implicated. Penile SCC occurs almost exclusively in uncircumcised men, and neonatal circumcision is believed to be protective. Penile carcinoma is most often found on the glans (48%), followed by the foreskin (21%), corona (6%), and shaft (< 2%). It is believed that smegma, more commonly present in uncircumcised men, induces chronic inflammation and predisposes to SCC. Any repetitive trauma or insult increases risk of SCC. Additional risk factors for anogenital SCC include smoking, sexually transmitted infections, HIV infection, human papillomavirus (HPV) infection, poor genital hygiene, anogenital injury, chronic balanitis, lichen sclerosus, and erosive lichen planus. Approximately 50% of genital SCC cases are associated with HPV infection.

Men who engage in receptive anal intercourse and men with immunocompromised states such as HIV should undergo regular anal cytology testing.

Related topics: bowenoid papulosiserythroplasia of Queyrat, squamous cell carcinoma in situ

Codes

ICD10CM:
C44.92 – Squamous cell carcinoma of skin, unspecified

SNOMEDCT:
402815007 – Squamous cell carcinoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Squamous cell carcinoma in situ
  • Nodular basal cell carcinoma
  • Common wart
  • Genital wart
  • Keratoacanthoma
  • Eccrine poroma
  • Lobular capillary hemangioma (pyogenic granuloma)
  • Amelanotic melanoma
  • Sporotrichosis
  • Mycobacterium marinum infection
  • Nummular dermatitis
  • Irritated Seborrheic keratosis
  • Lichen planus
  • Lichen sclerosus
  • Granuloma inguinale
  • Lymphogranuloma venereum
  • Secondary syphilis
  • Prurigo nodularis
  • Bowenoid papulosis
  • Microcystic adnexal carcinoma
  • Dermatofibrosarcoma protuberans
  • Cutaneous leiomyosarcoma
  • Extramammary Paget disease
  • Epithelioid sarcoma
  • Psoriasis
  • Lichen simplex chronicus
  • Basosquamous carcinoma of skin
  • Pseudoepitheliomatous keratotic and micaceous balanitis – may evolve to SCC if untreated

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:02/21/2023
Last Updated:04/06/2023
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Cutaneous squamous cell carcinoma - Anogenital in
See also in: Overview,Hair and Scalp,Nail and Distal Digit
A medical illustration showing key findings of Cutaneous squamous cell carcinoma (General) : Sun-exposed distribution
Clinical image of Cutaneous squamous cell carcinoma - imageId=178723. Click to open in gallery.  caption: 'An eroded nodule on the posterior pinna.'
An eroded nodule on the posterior pinna.
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