Abstract
Quaedvlieg P J F, Creytens D H K V, Epping G G, Peutz-Kootstra C J, Nieman F H M, Thissen M R T M & Krekels G A (2006) Histopathology 49, 256–264Histopathological characteristics of metastasizing squamous cell carcinoma of the skin and lipsAimsThe reported incidence of metastasis from squamous cell carcinoma (SCC) of the skin and lip varies between 0.5% and 16%. Clinical and histopathological criteria have been proposed to identify tumours that may have an increased risk of metastasis. The aim of this study was to define such high-risk tumours, especially since the incidence of SCC of the skin is increasing.Methods and resultsHistopathological features of metastasized skin and lip tumours and a matched group of non-metastasizing tumours were reassessed. Characteristics studied were: tumour width, excision margins, histological subtype, Clark level, Breslow depth, tumour differentiation, inflammation, perineural and angio-invasive growth, ulceration and desmoplasia. Data were statistically analysed separately for skin and labial lesions. Desmoplasia, Clark level, Breslow depth, maximum diameter, angio-invasion, grading, perineural invasion, plasma cells and eosinophilic inflammatory response proved to be statistically significantly related to metastasis of skin tumours. Breslow depth, plasma cells and grading appeared to be statistically significantly related to metastasis of SCC of the lips.ConclusionsA typical metastatic SCC showed: a tumour width of at least 15 mm, a vertical tumour thickness (= Breslow) of at least 2 mm, less differentiation, presence of desmoplasia and an inflammatory response with eosinophils and plasma cells.
Highlights
Squamous cell carcinoma (SCC) of the skin is the second most frequent malignant tumour in the headRe-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.and neck region and is associated with an appreciable rate of metastasis (0.5–16%).[1,2,3,4,5,6,7,8,9,10] The registration of SCCs is inadequate; many patients are treated in private practice and excised tumours sometimes have no histological verification
In our study we investigated what proportion of SCCs metastasize and if histopathological features can be identified to predict metastatic potential
Nineteen (28%) of the metastases were located in the locoregional lymph nodes, mostly ipsilateral
Summary
Squamous cell carcinoma (SCC) of the skin is the second most frequent malignant tumour in the head. Neck region and is associated with an appreciable rate of metastasis (0.5–16%).[1,2,3,4,5,6,7,8,9,10] The registration of SCCs is inadequate; many patients are treated in private practice and excised tumours sometimes have no histological verification. The potential for metastatic disease with SCC of the skin is often under-emphasized, especially among dermatologists who frequently handle malignant degeneration of actinic lesions. The potential for metastasis may be underestimated because patients presenting with tumour in a lymph node may not associate such metastasis with a. At present, it is unpredictable whether a SCC will metastasize or not
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