Squamous Cell Carcinoma: A Clinical and Histopathological Review of a South African Tertiary Dermatology Unit

Background: Cutaneous squamous cell carcinoma (CSCC) is the second most prevalent form of skin cancer globally. However, its incidence is rising relative to basal cell carcinoma (BCC) in countries such as Australia and the United States. In South Africa, where the population is exposed to numerous CSCC risk factors, including high ultraviolet radiation levels and a high burden of immunosuppression, there remains a notable paucity of scientific literature characterising the disease within this context. Aims: To describe the clinical, histopathological and risk profile characteristics of CSCC in a South African cohort to identify patterns that can inform local clinical practice and guide future research priorities. Methods: A retrospective data analysis of patients seen at Tygerberg Academic Hospital between 1 September 2019 and 31 August 2020 was conducted. Demographic and clinical data were extracted from medical records. Two study evaluators used predetermined criteria to review the histopathological features in skin biopsies. Risk stratification of lesions followed the guidelines of the National Comprehensive Cancer Network. Results: Over one year, 113 CSCCs were diagnosed in 83 patients. Participants were primarily Fitzpatrick skin phototype I (65.1%) and male (60.2%), with a median age of 73 years and a male-to-female ratio of 1.51:1. The BCC-to-CSCC incidence ratio was 1.71:1. Most lesions had been present for over 6 months (87.6%) and were located on the head and neck (59.3%). Punch biopsies diagnosed 62.8% of lesions. Histologically, 63.7% were well differentiated, and 40.7% were invasive. Conventional CSCCs comprised 75.2% of lesions; 5.3% were the high-risk acantholytic subtype. A high recurrence risk was found in 77.0% of lesions. Conclusion: This study highlights the heterogeneous nature of CSCC in South Africa and underscores the need for prospective, context-specific research to enhance prevention, early detection and management efforts nationwide.