Histologic Variants of Squamous Cell Carcinoma of the Skin

Margaret H. Rinker, MD; Neil A. Fenske, MD; Leigh Ann Scalf, MD, and L. Frank Glass, MD, Division of Dermatology and Cutaneous Surgery, Department of Internal Medicine at the University of South Florida, Tampa, Fla.

Cancer Control. 2001;8(4) 

In This Article

Papillary Squamous Cell Carcinoma

In 1990, Landman and colleagues[33] reported two patients with an unusual exophytic papillary growth pattern of SCC. They considered these tumors to be histologically distinct from verrucous carcinomas and referred to them as cutaneous papillary SCC. Both tumors occurred in elderly women and were located on the face. They presented as red nodules or tumors that clinically resembled SCC or pyogenic granuloma.

Histologically, they appear asexophytic, pedunculated masses with large papillary fronds permeated by fibrovascular cores. The cells adjacent to the stromal core are smaller with dark basophilic cytoplasm. The cells closer to the external surface show either clear or abundant pink cytoplasm.Nuclear atypia and mitotic figures can be readily seen. There may be only focal areas of invasion of the stroma with the tumor cells. A dense infiltrate of lymphocytes,plasma cells, and neutrophils was noted to permeate the stroma. In both reported cases, staining for HPV was negative. Unlike verrucous carcinoma, there was no evidence of downward growth of irregular strands of squamous cells infiltrating the dermis. In addition,the high degree of atypia and number of mitotic figures seen in these cases is not typical for verrucous carcinoma. Verrucous Bowen's disease may also demonstrate papillomatous projections;however, these do not have a fibrovascular core.

Both cases of papillary SCC were treated by electrodesiccation and curettage, and no evidence of recurrence was seen at a follow-up of 18 months. More cases are needed to adequately determine the biologic behavior of this variant of SCC.

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