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) 

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Desmoplastic Squamous Cell Carcinoma

Desmoplastic SCC is a new variant of SCC that was first described by Haneke[38] in 1989. Desmoplastic SCCs commonly occur on sun-exposed areas of the head and neck,with a high proportion of lesions being found on the ear. The histology demonstrates a prominent trabecular growth pattern, narrow columns of atypical epithelial cells,and a marked desmoplastic stromal reaction. A study done by Breuninger and colleagues[39] in 1997 reviewed 44 cases of desmoplasticSCC that were identified in a prospective review of 594 SCCs. All of the lesions were treated with standard micrographic surgery. The median follow-up for these patients was 5 years. The desmoplastic SCCs were found to metastasize six times more often than common SCCs (22.7% vs 3.8%) and have local recurrences 10 times more often that common SCCs (27.3% vs 2.6%). This poorer prognosis cannot be due to advanced tumor invasion because the desmoplastic SCCs were found to metastasize more often than typical SCCs of comparable tumor thickness.These authors recommended more aggressive treatment for desmoplastic SCCs, including wider excision margins, close follow-up with lymph node examination, and lymph node dissection for lesions deeper than 5 mm.

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