Imaging

Squamous Cell carcinoma of the skin

Preliminary Diagnosis: Squamous cell carcinoma of the skin

I. What imaging technique is first-line for this diagnosis

  • CT with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of squamous cell carcinoma of the skin.

Advantages

  • Relatively quick and inexpensive imaging modality.

  • Offers exquisite detail of the surrounding osseous structures.

Disadvantages

  • Exposes patients to ionizing radiation.

  • May be difficult to interpret in postoperative patients as fat planes and enhancement is distorted.

  • Less sensitive in detecting subtle primary tumor or metastatic lymph nodes compared with other imaging modalities

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients.

  • Relative contraindication to contrast use in patients with renal failure

  • Relative contraindication to contrast use in patients with contrast allergy

IV. What alternative imaging techniques are available?

  • MRI

  • PET/CT imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of squamous cell carcinoma of the skin.

MRI

Advantages

  • Does not expose the patient to ionizing radiation.

  • Highly sensitive and specific in detecting and detailing the extent of tumoral infiltration and any perineural infiltration.

Disadvantages

  • Less sensitive and less adept in detailing and detecting osseous involvement of neoplasm.

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

PET/CT imaging

Advantages

  • Highly sensitive and specific in detecting focal areas suspicious for primary and metastatic tumor.

  • Highly sensitive and specific in detecting residual or recurrent neoplasm post biopsy.

  • Gold standard in staging tumor.

  • High negative predictive value and may help alter treatment.

Disadvantages

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

MRI

  • May be contraindicated in patients with non-MR compatible hardware.

PET/CT imaging

  • May be contraindicated in patients who are pregnant and/or breastfeeding.

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