Skin Cancer Cutaneous Squamous Cell

Abstract

Usually due to UV light-induced DNA damage, keratinocytes in the epidermis proliferate abnormally, resulting in cutaneous squamous cell carcinoma (cSCC). Histological assessment is still the gold standard for identifying cSCC, but modern optical imaging diagnostic techniques enable doctors to perform \"optical or virtual biopsy\" in real time. Presenting a current literature review and advancements in optical imaging diagnostics for cSCC is our aim. Papers published between 2008 and 2022 were thoroughly evaluated using the PubMed, Embase, and Cochrane databases. Out of the 9581 total articles that the search yielded, 136 relevant articles that satisfied screening and eligibility criteria were included in the literature evaluation. This paper highlights the optical imaging techniques currently used to diagnose cSCC. The most recent advances in nonsurgical care of SCC were reviewed, despite the fact that surgical excision or Mohs micrographic surgery is still regarded as the gold standard. The review of the literature leads us to the conclusion that modern optical imaging tools, including multiphoton tomography, optical coherence tomography, line-field confocal optical coherence tomography, and confocal microscopy, have transformed real-time diagnostic imaging in dermatology, especially in the field of skin cancer. Rapid diagnosis and therapy beginning are made possible by these gadgets. Patients with multifocal cSCC, for whom many biopsies would be impractical, or high-risk patients (such as those who have received organ transplants or are exposed to prolonged UV radiation) may benefit from the use of modern imaging technologies in the management of cSCC, therefore avoiding needless biopsies. Optical imaging technology, in conjunction with dermoscopy, can enhance diagnostic efficiency by decreasing turnaround time

Introduction

Cutaneous squamous cell carcinoma (cSCC) arises from malignant transformation of epidermal keratinocytes and is strongly linked to prolonged ultraviolet (UV) radiation exposure. Its incidence has risen sharply worldwide. Key risk factors include sun exposure (especially UV), immunosuppression, genetic disorders (e.g., xeroderma pigmentosum), prior skin lesions like actinic keratosis, exposure to carcinogens like arsenic, and human papillomavirus (HPV) infection.

Etiology and Pathogenesis:
UV radiation (UVA and UVB) causes DNA damage, notably mutations in the tumor suppressor gene TP53, impairing DNA repair and promoting tumor development. Other environmental carcinogens and genetic syndromes that impair DNA repair or immune function also contribute. HPV oncoproteins E6 and E7 disrupt cell cycle regulation, facilitating carcinogenesis mainly in early stages. cSCC progression follows a multistage model beginning with actinic keratosis, advancing to in situ carcinoma, and potentially invasive cancer.

Diagnosis:
Diagnosis relies on clinical evaluation, dermoscopy, biopsy, and emerging noninvasive tools like reflectance confocal microscopy. Differential diagnosis is necessary to distinguish cSCC from other skin lesions.

Treatment:

• Primary treatment is surgical excision or Mohs micrographic surgery, with adequate margins to prevent recurrence.

• Radiation therapy is used for patients who are not surgical candidates or as adjuvant therapy in high-risk cases.

• Chemotherapy with platinum agents is reserved for advanced or metastatic cases but has significant toxicity.

• Targeted therapies and immunotherapies (immune checkpoint inhibitors) have emerged as promising options for advanced cSCC, with ongoing research into neoadjuvant and systemic therapies. Some treatments for other skin cancers (like BRAF and Hedgehog inhibitors) may paradoxically increase cSCC risk.

Prognosis and Research:
Molecular profiling, including gene expression tests, enhances risk stratification and personalized treatment. Despite high mutation burdens in cSCC, no specific oncogenic drivers have been conclusively identified. Advances in immunotherapy and targeted therapy are improving outcomes, especially in advanced disease.

Conclusion

Even with a multidisciplinary approach, advanced squamous cell carcinomas are challenging for clinicians to treat. The prevention and identification of early-stage tumours that can result in a great prognosis are equally crucial, but novel treatments are required because advanced tumours frequently do not respond to traditional treatment choices. Although the majority of novel treatments are currently undergoing clinical trials or require approval, their therapeutic benefits are undeniable. As a result, innovative targeted medicines with few adverse effects for patients depend on a deeper comprehension of the pathophysiology of cSCC and the molecular, genetic, and epigenetic factors underlying tumour cell behaviours. The accuracy of skin cancer diagnosis could be greatly increased by integrating CAD algorithms. The types of AI models utilised, the nationalities of the researchers, the publication years, and the geographic locations of the studies are only a few of the features of research in the field of HSI for skin cancer detection that we have methodically categorised and investigated in this study. The worldwide efforts and various strategies used to use HSI for skin cancer diagnosis are demonstrated by this thorough analysis. Nonetheless, it\'s critical to recognise the current constraints in this area. Relevant research has noted limitations such low patient involvement and a lack of readily available training datasets and imaging data. These difficulties show how much more cooperation and data sharing are required. Collaboration to maximise the effectiveness of HSI technologies in the identification of skin cancer. Going forward, improving the early detection and individualised treatment of skin cancer will be made possible by sustained HSI research and innovation as well as a dedication to resolving these limitations. Studies using HSI have shown increased precision in the early identification and distinction of skin cancer forms, including squamous cell carcinoma, basal cell carcinoma, and melanoma.

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Copyright

Copyright © 2025 Mr. Prathamesh Gaikwad, Ms. Pooja Gaikwad, Mr. Vijay Dabade, Mr. Akash Badhe, Mr. Nitin Gawai, Ms. Sarika Lakade . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.