Nonmelanoma Skin Cancer, Squamous Cell Carcinoma, Teledermatology



  1. Jacob, Sharon E.
  2. Patel, Amy A.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of a growth on the upper back.


Article Content


In the store and forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the Teledermatology Viewpoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual Teledermatology Report.




Chief Complaint

Presenting for diagnosis of a lesion on the upper back.


History of Present Illness

A 56-year-old gentleman who presents with "nonhealing sore spot" on his upper back that he states just grew and has kept growing over the course of 8 months. Prior treatment: none. His primary symptoms: soreness and bleeding. Prior biopsy: none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.



Fully satisfactory.



One image was provided that shows a well-demarcated red-brown flat nodule with a keratotic mesa-like surface and a rupioid, limpet-like, scaled plaque (suggesting hyperkeratosis) at the peripheral edge between 5 and 8 o'clock. No size indicator is included on the photograph (see Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. A well-demarcated red-brown flat nodule with a rupioid, limpet-like, scaled plaque at the peripheral edge.


Lesion A


The presented lesion is highly suspicious for a keratinizing squamous cell carcinoma (SCC).



Skin Care and Treatment Recommendations

Patient is to present to dermatology for a confirmatory biopsy. Patient is to be advised to utilize broad-spectrum sunscreens and sun protective clothing to avoid prolonged exposure to sunlight between the hours of 10 A.M. and 4 P.M. and have regular skin checks with dermatology.



Type of Visit

Return for a face-to-face visit for evaluation and biopsy with the dermatology nurse practitioner or dermatologist.



SCC is a common skin cancer that typically manifests on sun-exposed areas of the body. SCC accounts for 20% of nonmelanoma skin cancers and is the second most common cutaneous malignancy after basal cell carcinoma, with an age-adjusted incidence of 49.6-139.8 per 100,000 persons per year in the United States (Karla, Han, & Schmults, 2012). SCC arises from cell-damaging mutations in squamous cells of the epidermis, usually secondary to excessive ultraviolet radiation. Subsequent generations of these cells are thus damaged. Although SCC is typically localized to the upper skin layers and can be easily removed, it can penetrate into deeper layers and occasionally metastasize to distant organs and tissues, significantly decreasing the chance of a cure. Diseases associated with an increased risk of SCC are burns, osteomyelitis, chronic ulcers, discoid lupus erythematous, immune suppression, xeroderma pigmentosum, albinism, epidermolysis bullosa dystrophica, dyskeratosis congenita, and epidermodysplasia verruciformis (Skidmore & Flowers, 1998). Radiation, immunosuppressive medications (e.g., cyclosporine), psoralen and ultraviolet A phototherapy, polycyclic hydrocarbon, human papillomavirus, and arsenic exposure have also been reported in association (Bernstein, Lim, Brodland, & Heidelberg, 1996).




Bernstein S. C., Lim K. K., Brodland D. G., Heidelberg K. A. (1996). The many faces of squamous cell carcinoma. Dermatologic Surgery, 22(3), 243-254. [Context Link]


Karla P. S., Han J., Schmults C. D. (2013). Cutaneous squamous cell carcinoma: Estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. Journal of the American Academy of Dermatology, 68(6), 957-966. [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287.


Skidmore R. A. Jr., Flowers F. P. (1998). Nonmelanoma skin cancer. The Medical Clinics of North America, 82(6), 1309-1323. [Context Link]


1The standardized teledermatology reader report format is available for authors in Table 1 and on the Journal's Web site ( [Context Link]