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Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic
classification--part two. J Cutan Pathol 2006
Apr;33(4):261-79
Cutaneous
squamous cell carcinoma (SCC) includes many subtypes with widely
varying clinical behaviors, ranging from indolent to aggressive tumors
with significant metastatic potential. However, the tendency for
pathologists and clinicians alike is to refer to all squamoid
neoplasms as generic SCC. No definitive, comprehensive
clinicopathological system dividing cutaneous SCCs into categories
based upon their aggressiveness has yet been promulgated. Therefore,
we have proposed the following based upon the malignant potential of
SCC variants, separating them into categories of low (< or = 2%
metastatic rate), intermediate (3-10%), high (greater than 10%), and
indeterminate behavior. Low-risk SCCs include SCC arising in actinic
keratosis, HPV-associated SCC, tricholemmal carcinoma, and spindle
cell SCC (unassociated with radiation). Intermediate-risk SCCs include
adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion,
and lymphoepithelioma-like carcinoma of the skin. High-risk subtypes
include de novo SCC, SCC arising in association with predisposing
factors (radiation, burn scars, and immunosuppression), invasive
Bowen's disease, adenosquamous carcinoma, and malignant proliferating
pilar tumors. The indeterminate category includes signet ring cell SCC,
follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid
eccrine ductal carcinoma, and clear-cell SCC. Subclassification of SCC
into these risk-based categories, along with enumeration of other
factors including tumor size, differentiation, depth of invasion, and
perineural invasion will provide prognostically relevant information
and facilitate the most optimal treatment for patients.
Squamous cell carcinoma of the nail apparatus: clinicopathological
study of 35 cases. Br J Dermatol.2007 Jan 29;
Background
Subungual squamous cell carcinoma (SCC) is rare. Its diagnosis is
often missed or delayed because the clinical presentation is often
atypical and can mimic other conditions such as verruca vulgaris,
onychomycosis, trauma-induced nail dystrophy or exostosis. Objectives
To define the different clinical presentations and the main
pathological features and to evaluate the most appropriate surgical
management of subungual SCC. Methods A retrospective review of all the
cases of subungual SCC seen in our institution over a 5-year period.
Results Thirty-five cases were selected. The spectrum of the clinical
features encountered was extremely large including leuconychia,
subungual hyperkeratosis, trachonychia, subungual tumoral syndrome,
longitudinal erythronychia and melanonychia. Most cases (31 of 35)
were invasive. Relapse rate after surgical treatment was low after
wide surgical excision (5%) of the nail apparatus or amputation of the
digit. However, limited surgical excision led to more frequent
relapses (56%). Conclusions Nail apparatus SCC is often misdiagnosed.
Most cases are invasive at the time of diagnosis. Wide surgical
excision bears a lower risk of relapse. Micrographic surgery should be
considered for a better control in cases treated with limited surgical
excision.
Squamous cell carcinoma of the skin: dual differentiations to rare
basosquamous and spindle cell variants. J Cutan
Pathol. 2006 Mar;33(3):246-52
Basosquamous
carcinoma (BSC) is defined as a tumor containing the areas of both
basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with a
transition zone linking the two. Spindle cell squamous carcinoma (SCSC)
may have a variable component of conventional SCC and spindle cells.
We present a case of an 89-year-old woman with an eruption on the
scalp for several decades. Grossly, the lesion measured 8.5 x 6.0 x
1.8 cm and consisted of a gray-white and focally black tumor.
Microscopically, a non-ulcerated upper part of the tumor consisted of
large polygonal squamoid cells with occasional keratinization (SCC),
trabecular growth of basaloid cells with peripheral palisading (BCC),
and an area in which both the components were intermingled. The rest
of the tumor was a myxoid area with elongated fusiform spindle cells,
which appeared to arise from conventional SCC. Immunohistochemically,
the tumor cells in the SCSC (both conventional and spindle cell) area
co-expressed CAM5.2, and vimentin. Ber-EP4 was positive in the BCC
area with the transition zone of SCC and BCC showing diminished
staining. Epithelial membrane antigen was focally positive in the
conventional SCC area. To our knowledge, this is the first case report
of SCC of the skin that has dual differentiations to BSC and SCSC.
A
clinicopathological and immunohistochemical comparison of squamous
cell carcinoma arising in scars versus nonscar SCC in Japanese
patients.
Squamous cell
carcinoma (SCC) of the skin shows an indolent prognosis in general.
However, the prognosis of SCC arising in a scar (scar carcinoma) is
considered to be worse than that of SCC without any clinical history
of injury (nonscar SCC). The aim of this study was to compare several
indices, p53, Ki-67, E-cadherin, and beta-catenin, which are related
to tumor behavior, between scar carcinoma and nonscar SCC
clinicopathologically and immunohistochemically. The materials were
from 10 cases of scar carcinoma and 10 cases of nonscar SCC.
Clinicopathologically, the mean ages at diagnosis of scar carcinoma
and nonscar SCC were 59.2 and 71.2, respectively. The most frequent
anatomic site of scar carcinoma was the limbs. The most common cause
of scars in our study was burns. The mean duration from the initial
injury to the diagnosis of carcinoma was 30.5 years.
Immunohistochemically, the mean labeling index (calculated as the
percentage of positive cells) of p53 was 16.5 and 58.6 in scar
carcinoma and nonscar SCC, respectively (P < 0.01, Welch test). The LI
of Ki-67 was 19.1 in scar carcinoma and 52.1 in nonscar SCC (P < 0.01,
Welch test). The rates of positivity of the other proteins, such as E-cadherin
and beta-catenin, were similar between scar carcinoma and nonscar SCC.
In this study, the follow-up time was short and the number of patients
was small, and for these reasons it might not have been possible to
obtain evidence that scar carcinoma is aggressive.
Rare and newly described histological variants of cutaneous squamous
epithelial carcinoma. Classification by histopathology, cytomorphology
and malignant potential. Hautarzt 2001
Apr;52(4):288-97
The histological
spectrum of squamous cell carcinoma (SCC) of the skin is presented,
including recently mentioned and rarely appearing tumor subtypes.
Beside the most frequently occurring common SCC with variable degree
of differentiation, the following tumor forms can be identified
microscopically: Bowen-SCC, acantholytic SCC, clear cell SCC, spindle
cell SCC, keratoacanthoma-like SCC, desmoplastic SCC, neurotrophic SCC,
verrucous SCC, adenosquamous carcinoma and basosquamous cell
carcinoma. The classification of lymphoepithelioma-like carcinoma as a
cutaneous SCC variant is disputed, because epidermal connections are
regularly absent and evidence of glandular and follicular
differentiation suggest an adnexal origin. Beside the description of
distinctive histological and cytomorphological features of each SCC
subtype, important differences in malignant behavior and clinical
course are emphasized. |
