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Difference between revisions of "Squamous cell carcinoma of the skin"
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Squamous cell carcinoma of the skin (view source)
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = SkinTumors-P5290099.JPG | ||
| Width = | | Width = | ||
| Caption = | | Caption = Squamous cell carcinoma. [[H&E stain]]. | ||
| Micro = | | Micro = | ||
| Subtypes = | | Subtypes = many see ''[[squamous cell carcinoma]]'' | ||
| LMDDx = | | LMDDx = [[inverted follicular keratosis]], [[Paget disease of the breast]], [[eccrine carcinoma]], [[atypical fibroxanthoma]], [[malignant melanoma]], [[leiomyosarcoma]], [[basal cell carcinoma]] (for ''[[basaloid squamous cell carcinoma]]''), [[porocarcinoma]], [[pseudoepitheliomatous hyperplasia]] | ||
| Stains = | | Stains = | ||
| IHC = CK5/6 +ve, p63 +ve, K903 +ve, Ber-EP4 -ve, S-100 -ve | | IHC = CK5/6 +ve, p63 +ve, K903 +ve, [[Ber-EP4]] -ve, S-100 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = scaly patch or nodule, +/-ulceration | ||
| Grossing = | | Grossing = | ||
| Staging = [[Squamous_cell_carcinoma_of_the_skin#Staging|squamous cell carcinoma of the skin staging]] | |||
| Site = [[skin]] - usu. sun exposed areas | | Site = [[skin]] - usu. sun exposed areas | ||
| Assdx = [[actinic keratosis]], [[solar elastosis]] | | Assdx = [[actinic keratosis]], [[solar elastosis]] | ||
| Line 48: | Line 49: | ||
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref> | ***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref> | ||
==Gross== | |||
Features:<ref name=pmid15526735 >{{Cite journal | last1 = Stulberg | first1 = DL. | last2 = Crandell | first2 = B. | last3 = Fawcett | first3 = RS. | title = Diagnosis and treatment of basal cell and squamous cell carcinomas. | journal = Am Fam Physician | volume = 70 | issue = 8 | pages = 1481-8 | month = Oct | year = 2004 | doi = | PMID = 15526735 }} | |||
</ref> | |||
*Scaly patches/nodules. | |||
*Usu. erythematous. | |||
*+/-Ulceration. | |||
*"Keratin" plugs appearance. | |||
Notes: | |||
*Typically sun exposed areas. | |||
==Microscopic== | ==Microscopic== | ||
*See ''[[squamous cell carcinoma]]''. | *See ''[[squamous cell carcinoma]]''. | ||
| Line 56: | Line 67: | ||
*>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect. | *>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect. | ||
*[[Lymphovascular invasion]]. | *[[Lymphovascular invasion]]. | ||
*Perineural invasion. | *[[Perineural invasion]]. | ||
*Poorly differentiated. | *Poorly differentiated. | ||
| Line 67: | Line 78: | ||
*[[Malignant melanoma]]. | *[[Malignant melanoma]]. | ||
*[[Paget disease of the breast]]. | *[[Paget disease of the breast]]. | ||
*[[Eccrine carcinoma]] | *[[Eccrine carcinoma]]. | ||
*[[Basal cell carcinoma]] for [[basaloid squamous cell carcinoma]]. | |||
*[[Porocarcinoma]]. | |||
*[[Pseudoepitheliomatous hyperplasia]]. | |||
===Grading=== | |||
*G1 - well differentiated - easily recognizable as squamous, abundant keratinization. | |||
*G2 - moderately differentiated - keratinization focal (typically limited to keratin pearls, individual cells or horn cysts). | |||
*G3 - poorly differentiated - difficult to establish as squamous. | |||
*G4 - undifferentiated or anaplastic. | |||
====Images==== | |||
<gallery> | |||
Image: SkinTumors-P9020701.jpg | SCC - anaplastic. (WC) | |||
</gallery> | |||
===Bowen disease=== | ===Bowen disease=== | ||
| Line 86: | Line 111: | ||
Image:Bowen_disease_%283%29.jpg | Bowen disease - 3. (WC) | Image:Bowen_disease_%283%29.jpg | Bowen disease - 3. (WC) | ||
</gallery> | </gallery> | ||
==IHC== | ==IHC== | ||
Bowen's disease panel: | Bowen's disease panel: | ||
| Line 95: | Line 121: | ||
*CK7 -ve. | *CK7 -ve. | ||
**Toker cells CK7 +ve.<ref name=pmid19601945>{{Cite journal | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month = | year = | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref> | **Toker cells CK7 +ve.<ref name=pmid19601945>{{Cite journal | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month = | year = | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref> | ||
Others: | |||
*[[Ber-EP4]] usually -ve.<ref name=pmid19187107>{{Cite journal | last1 = Yu | first1 = L. | last2 = Galan | first2 = A. | last3 = McNiff | first3 = JM. | title = Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma. | journal = J Cutan Pathol | volume = 36 | issue = 10 | pages = 1074-176 | month = Oct | year = 2009 | doi = 10.1111/j.1600-0560.2008.01223.x | PMID = 19187107 }}</ref> | |||
** Usually +ve in [[BCC]]. | |||
==Staging== | |||
===Tumour stage=== | |||
{| class="wikitable sortable" | |||
!T stage | |||
!Criteria | |||
!Comment | |||
|- | |||
| T1 | |||
| <=2 cm ''and'' less than two high-risk factors | |||
| see ''microscopic'' for list of high-risk factors | |||
|- | |||
| T2 | |||
| >2 cm and less than two high-risk factors ''or'' two or more high-risk factors | |||
| see ''microscopic'' for list of high-risk factors | |||
|- | |||
| T3 | |||
| tumour into nearby bone - maxilla, mandible, orbit, temporal bone | |||
| uncommonly seen by pathology | |||
|- | |||
| T4 | |||
| tumour into axial skeleton or appendicular skeleton or perineural invasion of skull base | |||
| basically never seen by pathology | |||
|} | |||
==Sign-out== | ==Sign-out== | ||
===Invasive SCC=== | ===Invasive SCC - small=== | ||
<pre>Scalp Lesion, Excision: | |||
- INVASIVE SQUAMOUS CELL CARCINOMA, well-differentiated. | |||
-- Margins NEGATIVE for carcinoma in situ and NEGATIVE for malignancy. | |||
--- Closest margin (deep margin): 4 mm. | |||
-- Maximal tumour dimension: 1.2 cm. | |||
-- NEGATIVE for lymphovascular invasion. | |||
-- NEGATIVE for perineural invasion. | |||
- Extensive solar elastosis. | |||
</pre> | |||
===Invasive SCC - large=== | |||
<pre> | |||
Skin Lesion, Mid-Back, Excision: | |||
- Invasive SQUAMOUS CELL CARCINOMA, moderately differentiated. | |||
- Margins NEGATIVE for carcinoma in situ and NEGATIVE for malignancy. | |||
-- Closest margin: > 10 mm. | |||
-- TNM stage: pT2 pN0. | |||
- Extensive solar elastosis. | |||
- Two benign lymph nodes (0/2). | |||
- Please see synoptic report. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
SKIN, SITE, BIOPSY: | SKIN, SITE, BIOPSY: | ||
| Line 154: | Line 231: | ||
====Micro==== | ====Micro==== | ||
The sections show hair bearing skin. The squamous epithelium has full thickness changes including an increased nuclear-cytoplasmic ratio, loss of polarity, and nuclear hyperchromasia. Mitoses are seen in the upper third of the epithelium. Nucleoli are not apparent. No atypical cells are seen in the dermis. Parakeratosis overlies the abnormal keratinocytes. Solar elastosis is present. No melanocytic nests are identified. | The sections show hair bearing skin. The squamous epithelium has full thickness changes including an increased nuclear-cytoplasmic ratio, loss of polarity, and nuclear hyperchromasia. Mitoses are seen in the upper third of the epithelium. Nucleoli are not apparent. No atypical cells are seen in the dermis. Parakeratosis overlies the abnormal keratinocytes. Solar elastosis is present. No melanocytic nests are identified. | ||
=====Alternate===== | |||
The sections show hair bearing skin. The squamous epithelium has full thickness changes including increased nuclear-cytoplasmic ratio, nuclear enlargement, loss of polarity, and nuclear hyperchromasia. Mitotic figures are easily identified. | |||
No atypical cells are seen in the dermis; however, the epidermis is thickened. The dermal epidermal interface has a smooth contour. No paradoxical differentiation is identified. Inflammation at the dermal epidermal junction is minimal. Parakeratosis overlies the normal keratinocytes. The lesion is completely excised in the plane of section. Dermal scarring is present. | |||
==See also== | ==See also== | ||
*[[Dermatologic neoplasms]]. | *[[Dermatologic neoplasms]]. | ||
*[[Squamous cell carcinoma]]. | |||
==References== | ==References== | ||