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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#redirect [[Dermatologic_neoplasms#Squamous_cell_carcinoma_of_the_skin]]
'''Squamous cell carcinoma of the skin''' is a common malignant neoplasm of the skin.
 
It is abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
 
The general topic of ''squamous cell carcinoma'', also ''squamous carcinoma'', is dealt with in the ''[[squamous cell carcinoma]]'' article.
 
==General==
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*[[Actinic keratosis]] (solar keratosis).
**Clinical: yellow-brown scaly, patches, sandpaper sensation.
 
Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*Sun exposure.
*Immune suppression (e.g. organ transplant recipients).
 
Notes:
*[[Keratoacanthoma]].
**Some don't believe this entity exists.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>
 
==Microscopic==
*See ''[[squamous cell carcinoma]]''.
 
High risk features - for SCC of the skin:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf]. Accessed on: 29 March 2012.</ref>
*Primary site is ear ''or'' lip.†
*Clark level IV/V = reticular dermis or deeper.
*>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect.
*[[Lymphovascular invasion]].
*Perineural invasion.
*Poorly differentiated.
 
Note:
* † The words used are "hair-bearing lip" - but there is considerable confusion about this as the AJCC manual contradicts itself.<ref name=pmid21151529>{{Cite journal  | last1 = Buethe | first1 = D. | last2 = Warner | first2 = C. | last3 = Miedler | first3 = J. | last4 = Cockerell | first4 = CJ. | title = Focus Issue on Squamous Cell Carcinoma: Practical Concerns Regarding the 7th Edition AJCC Staging Guidelines. | journal = J Skin Cancer | volume = 2011 | issue =  | pages = 156391 | month =  | year = 2011 | doi = 10.1155/2011/156391 | PMID = 21151529 | PMC = 2990020 | URL = http://www.hindawi.com/journals/jsc/2011/156391/ }}</ref>
 
DDx:
*[[Inverted follicular keratosis]].
*[[Bowen disease]].
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine carcinoma]]
 
===Bowen disease===
'''Bowen disease''' is ''[[squamous cell carcinoma]] in situ'' of the skin. 
*Its histomorphologic appearance may be similar to [[Paget disease of the breast]]/[[Extramammary Paget disease]], Toker cell hyperplasia and [[melanoma]]. 
**[[IHC]] is used to separate the entities definitively.
 
Histologic DDx of Bowen disease:
*Benign Toker cell hyperplasia.
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine carcinoma]].
 
====Images====
<gallery>
Image:Bowen_disease_%281%29.jpg | Bowen disease - 1. (WC)
Image:Bowen_disease_%282%29.jpg | Bowen disease - 2. (WC)
Image:Bowen_disease_%283%29.jpg | Bowen disease - 3. (WC)
</gallery>
==IHC==
Bowen's disease panel:
*CK5/6 +ve.<ref>RS. May 2010.</ref>
**Usu. -ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]].
*S100 -ve, HMB-45 -ve.
**Both typically +ve in melanoma.
*CEA -ve<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-workup#a0721 http://emedicine.medscape.com/article/1101235-workup#a0721]. Accessed on: 2 September 2011.</ref> (+ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]], -ve in Toker cells).
*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>
 
==Sign-out==
===Invasive SCC===
<pre>
SKIN, SITE, BIOPSY:
- MODERATELY-DIFFERENTIATED INVASIVE SQUAMOUS CELL CARCINOMA, SEE COMMENT.
- NEGATIVE FOR LYMPHOVASCULAR INVASION.
- NEGATIVE FOR PERINEURAL INVASION.
 
COMMENT:
The nearest margin (lateral margin) is 1 mm.  The tumour is 9 mm in maximal dimension.
</pre>
 
<pre>
SKIN LESION, SITE, EXCISION:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY-DIFFERENTIATED.
-- TUMOUR GREATEST DIMENSION: ___ CM.
-- TUMOUR THICKNESS: ___ MM.
-- LATERAL MARGINS: NEGATIVE FOR IN SITU CARCINOMA AND INVASIVE CARCINOMA.
-- DEEP MARGIN: NEGATIVE FOR INVASIVE CARCINOMA.
-- NEAREST MARGIN: 1 MM, LATERAL MARGIN.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN, SITE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, SEE TUMOUR SUMMARY.
 
TUMOUR SUMMARY:
Histologic type: squamous cell carcinoma, type not otherwise specified.
Histologic grade: moderately differentiated.
Greatest dimension: ___ cm.
Tumour thickness: ___ mm.
Peripheral margin: negative for invasive carcinoma and in situ carcinoma.
Deep margin (invasive component): negative for invasive carcinoma.
Closest margin: deep margin, ___ mm.
Lymphovascular invasion: not identified.
Perineural invasion: not identified.
</pre>
 
===Bowen's disease===
<pre>
SKIN LESION, RIGHT EAR, BIOPSY:
- SQUAMOUS CELL CARCINOMA IN SITU (BOWEN'S DISEASE), INCOMPLETELY EXCISED.
 
COMMENT:
Complete excision of the lesion is recommended.
</pre>
 
<pre>
SKIN LESION, CHEST, EXCISIONAL BIOPSY:
- SQUAMOUS CELL CARCINOMA IN SITU (BOWEN'S DISEASE), COMPLETELY EXCISED.
- SOLAR ELASTOSIS, MILD.
</pre>
 
====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.
 
==See also==
*[[Dermatologic neoplasms]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Dermatologic neoplasms]]
Michael
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