Squamous cell carcinoma of the skin presents as which lesion, and in which population is the risk increased?

• A. Pearly, telangiectatic papule
• B. Hyperkeratotic crusted papule or plaque; increased risk in solid organ transplant recipients on chronic immunosuppression
• C. Vesicular lesion
• D. Flat pigmented macule

Answer: (B)

Squamous cell carcinoma of the skin most often presents as a hyperkeratotic crusted papule or plaque that may ulcerate. This appearance reflects malignant keratinocytes forming a rough, scaly surface. The risk is notably increased in solid organ transplant recipients on chronic immunosuppression because reduced immune surveillance allows actinic damage to progress to cancer and can lead to more aggressive tumors in this group.

The other descriptions fit different conditions: a pearly, telangiectatic papule is typical of basal cell carcinoma; a vesicular lesion suggests an infectious or inflammatory vesicle process; a flat pigmented macule is more characteristic of melanoma or other pigmented lesions.