|The 85-year-old lady presented with complaints of: Swelling on Right Foot since 2 months. The patient was normal 2 months back when she noticed swelling on the Right Foot. |
Initially swelling was 1cm x 1cm in size and has gradually progressed to the current size of 10cm x 8cm and 5cm x 4cm
Swelling is also associated with bloody discharge, spontaneous, minimal amount of bleeding, which stops on its own.
No h/o trauma No h/o pain on movement
No h/o skin change No h/o fever No h/o anorexia, weight loss No h/o similar swellings in other sites
Not a k/c/o Type 2 Diabetes Mellitus, Hypertension, Asthma, Epilepsy
|General Physical Examination: The patient is moderately built and nourished, is alert, cooperative, and well oriented No pallor, No icterus, No clubbing, No cyanosis, Right inguinal lymph node enlarged, No edema. |
Inspection: Two swellings present on the medial aspect of lower 1/3rd of the Right leg 1st swelling of size 10cm x 8cm just above the medial malleolus which is exophytic.
The surface appears irregular with ulceration & bloody discharge Margins are well defined, the skin over the swelling is ulcerated with necrotic patches 2nd swelling is 1cm above the first swelling, 5cm x 4cm in size, the surface appears irregular, margins are well defined The skin over the swelling is stretched and shiny with minimum ulceration
No scars/sinuses No other swellings are seen Passive movement at the ankle is normal but aggravates bleeding Insert Picture 1 Palpation: No local rise of temperature Tenderness + Solitary swelling, No ridge between the two masses
Other inspection findings confirmed Swelling is variable in consistency, non-mobile bleeds on touch, the skin over swelling is not pinchable
Examination of draining lymphatics: Solitary 1cm x 1cm lymph node, palpable in Right inguinal region Non-tender, freely mobile, and firm CVS: S1 &S2 heard, No added murmurs. RS: B/L NVBS, No added sounds. P/A: Soft and non-tender with no organomegaly. CNS: Conscious and oriented.
Hb – 9.6g/dL
ECG: Irregular missed beats
Aortic Valve Sclerosis with Mild Tricuspid Regurgitation with Pulmonary Artery Hypertension.
Xray of Right Leg: AP, Lateral
HIV – Negative
HbsAg – Negative
HCV – Negative
Squamous Cell Carcinoma over the medial aspect of Right foot
Wide Local Excision done under Spinal Anaesthesia
The tissue sample sent for Histopathological Examination showed high-grade sarcoma
Cutaneous squamous cell carcinoma (cSCC) is a malignant tumor arising from epidermal keratinocytes 
It is mainly caused by UV light exposure, which leads to widespread DNA damage and extremely high mutational loads 
These cancers can appear as:
•Rough or scaly red patches, which might bleed
•Raised growths or lumps
•Open sores (which may have oozing or crusted areas) that don’t heal or that heal and then come back
•Wart-like growths 
Squamous cell carcinoma (SCC) has a higher risk of metastasis.
In this case, the patient has inguinal lymph node enlargement indicative of metastasis.
A skin biopsy is mandatory in all patients with suspected squamous cell carcinoma. Histopathologically, squamous cell carcinoma is notable for irregular nests, cords, and sheets of neoplastic keratinocytes invading the dermis. 
Here, in this case, an X-Ray was taken to check the extent of invasion of the tumor, and a wide excisional biopsy was done to confirm the diagnosis.
The major preventive measure includes the use of appropriate sun-protective clothing, the use of broad-spectrum (UVA/UVB) sunscreen with at least SPF 50, and avoidance of intense sun exposure that may prevent this cancer. 
Surgical excision is the only means of providing accurate information on histology and clearance. A 4 mm clearance margin should be achieved if the SCC measures <2 cm and a 1 cm clearance margin if >2cm. 
Other procedures include:
Mohs Surgery (During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells) 
Radiation therapy is often used afterward in high-risk cancer or patient types
In the case of SCC in situ (Bowen’s disease) treatment includes photodynamic therapy with 5-aminolevulinic acid, cryotherapy, topical 5-fluorouracil or imiquimod, and excision.  The long-term prognosis of squamous cell carcinomas depends on: the sub-type of the carcinoma, available treatments, location(s) and severity, and various patient health-related variables (accompanying diseases, age, etc.). Generally, the long-term outcome is positive, as less than 4% of Squamous cell carcinoma cases are at risk of metastasis. 
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