Squamous cell carcinoma of the skin of the extremities

Nonmelanomatous skin cancer usually occurs in fair-skinned persons on sites chronically exposed to sunlight. In a series of 35,000 patients with skin cancer seen at M. D. Anderson Hospital and Tumor Institute, 1,208 patients (13%) had squamous cell skin cancer of the extremities. Forty-one of these patients had a clear history of a preexisting thermal burn or irradiation dermatitis (Marjolin's ulcer). The average lesion was over 2 cm in diameter, and the average Marjolin's ulcer was over 5 cm. The treatment of choice in this series of relatively large lesions was surgical excision with or without skin grafting and with histologic evaluation of the surgical margins. The local recurrence rate was less than 10%. Regional metastasis developed in 1.4% of the patients and in 44% of those with Marjolin's ulcer. Even with prompt nodal dissection, the five-year survival rate for patients with nodal metastasis was only 35%. The presence of extracapsular spread of nodal disease is of grave significance, and adjunctive radiation therapy should be considered. Careful follow-up of all patients with squamous cell skin cancer is important.