Pericanthal Squamous Cell Carcinoma (SCC) Management

Definition and Clinical Presentation

Pericanthal SCC typically presents as an indurated nodular keratinizing or crusted tumor that may ulcerate, or as an ulcer without evidence of keratinization, according to the British Journal of Dermatology 1

Chronic ultraviolet light exposure is the primary risk factor for pericanthal SCC, making it common in sun-damaged skin of fair-skinned individuals, as reported by the British Journal of Dermatology 1
Other risk factors for pericanthal SCC include previous exposure to ionizing radiation or arsenic, development within chronic wounds, scars, burns, ulcers or sinus tracts, pre-existing lesions such as Bowen's disease, immunosuppression, and human papillomavirus infection, according to the British Journal of Dermatology 1 and 2

Definitive diagnosis of pericanthal SCC is established histologically through biopsy, which should include pathological pattern, cell morphology, degree of differentiation, histological grade, depth, level of dermal invasion, and presence or absence of perineural, vascular or lymphatic invasion, as recommended by the British Journal of Dermatology 1

Size and depth of the tumor are significant prognostic factors, with tumors greater than 2 cm in diameter and greater than 4 mm in depth having higher recurrence and metastasis rates, according to the British Journal of Dermatology 1
Location in the periocular region, including the canthi, is considered a high-risk location due to proximity to critical structures and potential for perineural invasion, as noted by the British Journal of Dermatology 3

Surgical excision is the treatment of choice for the majority of pericanthal SCCs, with recommended margins of at least 4-mm for low-risk tumors and 6 mm or more for high-risk tumors, according to the British Journal of Dermatology 3

Perineural spread is a significant concern in pericanthal SCC, which may present with neurologic symptoms, and requires careful evaluation and monitoring, as reported by the Journal of the National Comprehensive Cancer Network 4

Regular follow-up is essential for pericanthal SCC, particularly for patients with high-risk features, who should be monitored closely for recurrence and metastasis, according to the Journal of the American Academy of Dermatology 6