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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Squamous cell carcinoma is a common tumor of the skin with potential for local recurrence and metastasis. It is important to determine which tumors are high risk in order to determine the appropriate treatments. Higher-risk tumors may require micrographic surgery,lymph node dissection, or even adjunctive radiation treatment. The histologic subtype has been considered as a possible variable in determining the prognosis of cutaneous SCC. Bowen's disease, KAs, and verrucous carcinomas appear to have a lower malignant potential than typical invasive SCCs. Several conflicting reports regarding the prognosis of acantholytic SCC have been published;however, a more recent report has not confirmed the higher malignant potential that was once suspected. Although some believe that spindle cell carcinoma may be more aggressive than conventional SCC, most reports of recurrence and metastasis occurred in patients with a previous history of radiation therapy or immunosuppression.It appears that spindle cell SCC arising de novo does not have a higher malignant potential.Due to the relatively small number of reported cases of clear cell, papillary,signet ring, and pigmented SCCs, it is difficult to make any definitive statements regarding their prognosis compared to typical invasive SCC. A preliminary review of the desmoplastic variant of SCC indicates a higher malignant potential than typical invasive SCC.

Other clinical and histologic factors that have been associated with a higher risk of local recurrence and metastasis include tumor size, depth of invasion, histologic differentiation, anatomic site, perineural invasion, rapid growth, history of previous treatment, host immunosuppression, and etiologic factors such as scar, chronic ulceration,or radiation.[3] In an extensive review in 1992, Rowe et al[3] noted that it is difficult to assess the relation between each of the prognostic factors because each factor is uncontrolled and overlaps with so many other factors. Large randomized,prospective trials are needed to determine the relative importance of each of the prognostic factors for SCC.


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