Squamous Cell Carcinoma of Skin

A 62-year-old farmer from rural Maharashtra presents with a non-healing ulcer on the dorsum of his left hand for 8 months. The lesion started as a small nodule and gradually enlarged. On examination, there is a hyperkeratotic, indurated plaque with central ulceration and rolled edges. Regional lymph nodes are palpable. What is the investigation of choice to confirm the diagnosis?

A 68-year-old farmer from rural Maharashtra with fair complexion presents with a hyperkeratotic, indurated nodule on the dorsum of his left hand that has been growing for 6 months. Biopsy confirms squamous cell carcinoma of the skin. What is the most common aetiological factor responsible for this malignancy?

A 55-year-old man with a 30-year history of occupational arsenic exposure presents with multiple hyperkeratotic papules on the palms and soles, along with a 2 cm indurated nodule on the dorsum of the right hand with irregular borders and central ulceration. Dermoscopy shows a vascular pattern with arborizing vessels. Histopathology reveals infiltrative nests of atypical keratinocytes with perineural invasion. Which of the following is the most likely diagnosis?

A 62-year-old man with a 2-year history of sun exposure presents with a 1.5 cm indurated nodule on the dorsum of his hand with central ulceration and raised, rolled edges. Biopsy confirms invasive SCC. Which clinical feature best distinguishes this high-risk SCC from a low-risk SCC of the same anatomical site?

A 72-year-old woman presents with a scaly, indurated nodule on the left temple that has grown over 6 months. She has a history of actinic keratosis in the same area. Dermoscopy reveals a hyperkeratotic plug with irregular vascular pattern. Excisional biopsy shows moderately differentiated squamous cell carcinoma with invasion into the subcutaneous fat and perineural invasion. The margins are clear (>5 mm). What is the most appropriate next step in management?