Simulators of Squamous Cell Carcinoma of the Skin: Diagnostic Challenges on Small Biopsies and Clinicopathological Correlation

  • Tan K
  • Tan S
  • Aw D
  • et al.
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Abstract

Squamous cell carcinoma (SCC) is a common and important primary cutaneous malignancy. On skin biopsies, SCC is characterized by significant squamous cell atypia, abnormal keratinization, and invasive features. Diagnostic challenges may occasionally arise, especially in the setting of small punch biopsies or superficial shave biopsies, where only part of the lesion may be assessable by the pathologist. Benign mimics of SCC include pseudoepitheliomatous hyperplasia, eccrine squamous syringometaplasia, inverted follicular keratosis, and keratoacanthoma, while malignant mimics of SCC include basal cell carcinoma, melanoma, and metastatic carcinoma. The careful application of time-honored diagnostic criteria, close clinicopathological correlation and a selective request for a further, deeper, or wider biopsy remain the most useful strategies to clinch the correct diagnosis. This review aims to present the key differential diagnoses of SCC, to discuss common diagnostic pitfalls, and to recommend ways to deal with diagnostically challenging cases.

Figures

  • Figure 1: Inverted follicular keratosis: lesion shows proliferative downgrowths of mature squamous epithelium with infundibular keratinization (H&E ×40).
  • Figure 3: Bowen disease: Shave biopsy specimen showing mainly papillomatous epidermal lesion with hyperkeratotic horn. Inset: closer view of the underlying lesional epidermis shows cells with nuclear pleomorphism, prominent nucleoli, and frequent and abnormal mitotic figures. (H&E, ×20; Inset: ×400).
  • Figure 2: Inverted follicular keratosis: higher magnification showing squamous eddies (H&E ×200).
  • Figure 4: Pseudoepitheliomatous hyperplasia featuring acanthotic squamous epithelium showing irregular thick finger-like downgrowths into the underlying dermis. (H&E, ×20).
  • Figure 5: Pseudoepitheliomatous hyperplasia: highermagnification view showing reactive-appearing squamous downgrowths with no significant cytologic atypia. The dermis shows mild chronic inflammation and granulation tissue formation (H&E, ×200).
  • Figure 8: Verrucous hyperplasia: low power magnification view showing epidermal squamous proliferation with broad and superficial downgrowths of the epidermis. Overlying hyper-and parakeratosis is present. There is no atypia or koilocytes. (H&E, ×100).
  • Figure 6: Infundibulocystic hyperplasia: skin lesion showing follicular proliferative process with bland squamous cells and formation of dilated canals containing keratotic material. (H&E, ×40).
  • Figure 9: Eccrine squamous syringometaplasia: bland appearing squamous islands in the dermis centered around eccrine lumina. Scattered lymphocytes are present in the surrounding dermis. (H&E, ×200).

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APA

Tan, K.-B., Tan, S.-H., Aw, D. C.-W., Jaffar, H., Lim, T.-C., Lee, S.-J., & Lee, Y.-S. (2013). Simulators of Squamous Cell Carcinoma of the Skin: Diagnostic Challenges on Small Biopsies and Clinicopathological Correlation. Journal of Skin Cancer, 2013, 1–10. https://doi.org/10.1155/2013/752864

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