1. Squamous Cell Carcinoma DH 125 Head and Neck Anatomy, Histology, and Embryology 12/9/15 Neda Sarlak #15 Susana Orlando #3 Wendy Moy #11 Samantha Strong #18

2. Case Study David Smith is a 55 year old, caucasian, retired construction worker. He has smoked cigarettes for 35+ years and drinks alcohol frequently. Today his appointment is for a regular cleaning, however he has not been seen for over a year. David’s chief complaint is that he has, what he believes, is a canker sore on his cheek. He explains that it has been sore for a few weeks now, and that chewing food is difficult. During the EO/IO you discover the lesion on the buccal mucosa on his right side. It is 8 mm, patchy white, elevated, and the surrounding tissue is inflamed.

4. Unmet Human Needs 1.Freedom from head and neck pain: -pain from sore in mouth and has difficulty chewing food. 2.Skin and mucous membrane integrity: -leukoplakia patch on right buccal mucosa

5. Dental Hygiene Intervention Freedom from head and neck pain: -perform EO/IO assessment to identify chief complaint -recommend or provide OTC oral products that provide temporary relief so that client can chew food. -recommend softer foods and to chew on other side of mouth until a diagnosis is determined Skin and mucous membrane integrity: -measure patch with probe, record in clients chart -immediately inform dentist of oral finding -refer to pathologist for evaluation and diagnosis

6. What Is It? Squamous Cell Carcinoma (SCC) is a common skin cancer that develops on the upper layer of the epidermis. Immunosuppression medication, prolong exposure to UV sunlight, tobacco, alcohol, and poor nutrition can cause the squamous cell to multiply causing the keratinocytes to become squamous cell carcinoma in the epithelium. 90% of oral cancers are SCC. It is typically found on the lips or lateral part of the tongue as a lump or ulcer. The lump can be red, white or mixed.

7. Who Is At Risk? There is a higher risk for developing SCC with people who have light or fair skin. It is more common in men who are in their 70’s, but in recent years, people who are in their 30’s and 40’s have been diagnosed. People who have blue/green/gray eyes are also at a higher risk for getting SCC.

8. Histology SCC results from genetic changes (mutations) in genes like all other cancers. A fully differentiated SCC is formed when a fully premalignant lesion progresses. The first characteristics is the presence of dysplasia. Dysplasia is alteration of cell morphology towards a malignant direction. These alterations include increase in the number of cells (proliferation), variation in size and shape of nuclei (pleomorphism), increase in nuclear chromatin, increase in size of nuclei relative to cytoplasm, and increased mitosis.

9. Premalignant lesion – cellular dysplasia

11. Histologically, a mature SCC is presented with disorganized squamous cells that can show a lot of mitotic activity indicating rapidly dividing cancerous cells. These malignant cells often form island and nests of neoplastic cells that grow in a disorderly fashion and can invade the neighboring tissue or metastasize to lymph nodes.

12. Treatment If caught early, treatment can be 90-100% effective Skin biopsy used to diagnose Option 1: Excision of growth Option 2: Radiation Option 3:Curretage and Electrodessication Option 4: Mohs (aka: micrographic) surgery

13. Sources -"Cancers of the Oral Mucosa.": Background, Pathophysiology, Epidemiology. N.p., n.d. Web. 18 Oct. 2015. -Mayo Clinic Staff. "Diseases and Conditions Squamous Cell Carcinoma of the Skin." N.p., 27 Nov. 2014. Web. 17 Oct. 2015. N.p., n.d. Web. 17 Nov. 2015. -"Skin Cancer Foundation." Squamous Cell Carcinoma (SCC). N.p., n.d. Web. 18 Oct. 2015. -"Squamous Cell Carcinoma." WebMD. WebMD, 2015. Web. 18 Oct. 2015. -Tamy. Skin Cancer – Squamous Cell Carcinoma. “Previse Skincare”. (16 January 2013). Web. 15 Oct. 2015. Retrieve from https://www.previsecare.com/skin- cancer-squamous-cell-carcinoma/ -Monroe, Marcus M., MD. "Skin Cancer Foundation." Squamous Cell Carcinoma (SCC). Ed. Arlen D. Meyers. Medscape, 10 July 2015. Web. 15 Oct. 2015. Retrieve from http://emedicine.medscape.com/article/1965430-overview -Cutaneous Squamous Cell Carcinoma. (n.d.). Retrieved October 15, 2015, retrieve from http://emedicine.medscape.com/article/1965430-overview

14. Quiz Describe a person who could be at high risk for developing SCC What is something a hygienist can do for a client who may be dealing with SCC? If caught early, how effective is treatment for SCC?