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Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Squamous Cell Carcinoma

Squamous cell carcinoma: Squamous cell carcinoma (SCC) often appears as a firm pink lump with a rough or hyperkeratotic surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface. The lump often feels tender when touched, bleeds easily and may develop into an ulcer. SCCs grow significantly quicker than BCCs (visible change over weeks rather than months). SCC predominantly arise on sun-exposed sites and there are often other signs of sun-damaged skin. 

The most commonly affected areas are the backs of hands and forearms, upper part of the face and, especially in males, the scalp, lower lip and pinna. For both SCC and BCC there can sometimes be considerable skin damage if the tumour is not treated. Approximately 25,000 squamous cell carcinomas of the skin are diagnosed each year. A full time GP is likely to diagnose at least one person with squamous cell carcinoma every 1–2 years. Death from squamous cell carcinoma is rare (<5%). The main advantage of early diagnosis is less extensive treatment. 

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

 Refer via urgent suspicion of cancer (USOC) 

High-risk - Factors relating to high-risk tumours: Diameter 2-4cm; Rapidly growing with less keratin production and irregular features; Location on ear or lip; Tumour arising within scar or area of chronic inflammation; Immunosuppression 

Refer via USOC 

Very High-risk - Factors relating to very high-risk tumours: Diameter >4cm; Organ transplant recipients; Haematological malignancies

Refer via USOC 

Referral Management

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

If alternative diagnoses (actinic keratosis or Bowen’s) have been suspected and treated surgically or non-surgically (topical therapies/cryotherapy), suspicions should be raised for possible SCC if there has been no response to these therapies within 3 months. 

Clinical resources

TNM Staging System - Basal and Squamous Cell Skin Cancer Stages (cancer.org) see also Cancer Research UK 

BAD SCC guidelines 2020 

NICE CKS – skin cancers – recognition and referral 

Patient.Info Doctors- Squamous Cell Carcinoma of Skin 

PCDS- Squamous Cell Carcinoma 

DermNet NZ- Cutaneous Squamous Cell Carcinoma 

Clinical tips

  • SCC predominantly arise in older patients, although immunosuppressed patients and the other high-risk groups e.g., xeroderma pigmentosum, can develop lesions at a much younger age 
  • Lesions may start de-novo or from pre-existing pre-cancerous skin lesions such as AK and Bowen's disease 
  • Transformation can also occur in areas of chronic inflammation such as leg ulcers 
  • Ulceration and granulation tissue more common than scale in poorly differentiated SCCs 
  • Pain/tenderness on palpation supports a diagnosis of SCC 
  • Can be difficult to distinguish from BCC. The latter can have diagnostic features of pearliness and telangiectasia and is more likely to have a history of spontaneous bleeding.  
  • SCCs increase in size significantly over several weeks; BCCs increase in size significantly over months 
  • SCC can be distinguished from AK and Bowen’s by looking for induration (thickening) beneath overlying keratin. When there is doubt lesions should be referred to secondary care.   
  • Beware of diagnosing a pyogenic granuloma in an elderly patient as this could be SCC or amelanotic melanoma 
  • Overlying scale/crust should be removed during clinical assessment where possible – to assess induration (suggestive of SCC)  
  • Have a higher index of suspicion/lower threshold for referral in immunocompromised patients, particularly transplant patients.

Patient information resources

  1. BAD Patient Information Leaflet - SCC 
  2. NHS page on non-melanoma skin cancers 
  3. DermnetNZ Patient Information Leaflet - SCC 
  4. NHS Inform Scotland- Skin Cancer (non-melanoma) 

ICD search categories

Malignant 

ICD11 code - 2C31 

Editorial Information

Last reviewed: 23/05/2023

Next review date: 23/05/2025

Author(s): Adapted from the BAD Referral Guidelines.

Version: BAD 1

Co-Author(s): Publisher: Centre for Sustainable Delivery, Scottish Dermatological Society.

Approved By: Scottish Dermatological Society