Garcia-Zuazaga Jorge, Olbricht Suzanne M
Department of Dermatology, Mohs Micrographic Surgery and Cutaneous Oncology, Lahey Clinic, Harvard Medical School, 41 Mall Road, Burlington, MA 01805, USA.
Adv Dermatol. 2008;24:33-57. doi: 10.1016/j.yadr.2008.09.007.
Cutaneous SCC is the second most common skin cancer among whites. Most cases of primary cutaneous SCC are induced by UV radiation. Chronic sun exposure is the major risk factor, and favored locations include the head and neck and other sun-exposed areas. Moreover, it is important for the clinician to recognize other risk factors associated with this malignancy, including HPV infection, occupational exposures, various genodermatoses, scarring dermatoses, chronic wounds, and burn scars. The allogenic transplant population is at most risk for developing cutaneous SCC. For these patients, aggressive patient education, control of immunosuppression, and clinical surveillance should be the standard of care. Most patients who have primary SCC have an excellent prognosis, and treatment is usually straightforward. A substantial minority of these neoplasms, however, may recur or metastasize. Obtaining a complete history and performing a total-body skin examination can help to identify tumors at high risk for recurrence or metastasis in addition to those that may be more easily treated. For those individuals with metastatic disease, however, the long-term prognosis is guarded. Based on recent reports, in the future, there may be a role in SLNB for cutaneous SCC to diagnose subclinical metastasis accurately. Larger studies and better guidelines need to be developed before SLNB can be routinely used in the management of metastatic disease. Physicians should emphasize to their patients the benefits of sun avoidance and protection from sunlight, beginning in childhood, to minimize the risk for developing this potentially life-threatening neoplasm.
皮肤鳞状细胞癌（SCC）是白人中第二常见的皮肤癌。大多数原发性皮肤SCC病例是由紫外线辐射诱发的。长期日晒是主要危险因素，好发部位包括头颈部和其他暴露于阳光的区域。此外，临床医生认识到与这种恶性肿瘤相关的其他危险因素也很重要，包括人乳头瘤病毒（HPV）感染、职业暴露、各种遗传性皮肤病、瘢痕性皮肤病、慢性伤口和烧伤瘢痕。同种异体移植人群发生皮肤SCC的风险最高。对于这些患者，积极的患者教育、免疫抑制的控制和临床监测应成为标准治疗措施。大多数原发性SCC患者预后良好，治疗通常很简单。然而，这些肿瘤中有相当一部分可能会复发或转移。除了那些可能更容易治疗的肿瘤外，获取完整病史并进行全身皮肤检查有助于识别有复发或转移高风险的肿瘤。然而，对于那些患有转移性疾病的个体，长期预后不容乐观。根据最近的报告，未来，前哨淋巴结活检（SLNB）在皮肤SCC中可能有助于准确诊断亚临床转移。在SLNB能够常规用于转移性疾病的管理之前，需要开展更大规模的研究并制定更好的指南。医生应向患者强调从童年开始避免日晒和防晒的益处，以将患这种潜在危及生命的肿瘤的风险降至最低。
