Spinocellular carcinoma

Last Updated: 2021-06-28

Author(s): Anzengruber F., Navarini A.

ICD11: -

Squamous cell carcinoma, spinalioma, epithelioma spinocellulare, carcinoma spinocellulare, cornifying squamous cell carcinoma of the skin, prickle cell carcinoma, spindle cell carcinoma, cornifying squamous cell carcinoma.

  • Epithelial carcinoma, which in rare cases can metastasise.

  • Second most common malignant skin tumour (Caucasian)
  • Incidence: 30/100,000 per year (north-south divide).
  • Average age: 70 years.
  • Men:Women = 2:1.
  • Spinocellular carcinomas account for about 20% of all non-melanoma skin cancer.
  • There has been a sharp increase in incidence in recent decades.

  • Histological classification:
  • Carcinoma in situ of the skin (KIN III)
  • Carcinoma in situ of the mucous membrane in penile, anal and vaginal carcinoma (PIN, AIN, VIN III)
  • Spinocellular carcinoma (classic type)
  • Acantholytic squamous cell carcinoma
  • Mucinsecreting squamous cell carcinoma
  • Desmoplastic squamous cell carcinoma
  • Small cell squamous cell carcinoma
  • Clear cell squamous cell carcinoma
  • Lymphoepithelioma-like carcinoma of the skin

  • In-situ carcinomas (actinic keratoses, Bowen's disease, Queyrat's erythroplasia, actinic cheilitis) are the precursors of SCC. However, squamous cell carcinomas can also develop from the begining. The etiopathogenesis is multifactorial.
  • This can be causal or predisposing:
  • Actinic keratoses.
  • Positive family history.
  • Light skin type.
  • Sun exposure (incl. solarium).
  • Ionising radiation.
  • High-risk human papilloma viruses.
  • Advanced age.
  • Chronic exposure to heat (erythema ab igne) or burns.
  • Chronic degenerative and chronic inflammatory skin changes.
  • Albinism.
  • Xeroderma pigmentosum.
  • Muir-Torre syndrome.
  • Epidermolysis bullosa hereditaria.
  • Scars (also Lupus vulgaris scars).
  • Atrophic lupus erythematosus foci.
  • Acrodermatitis chronica atrophicans.
  • Lower leg ulcer Marjolin ulcer (about 1:5000).
  • Acne inversa.
  • Lichen ruber erosivus mucosae.
  • Glossitis interstitialis syphilitica.
  • Lichen sclerosus et atrophicus of the vulva or penis.
  • Workers in oil refineries.
  • Coal tar industry.
  • Road construction with tar.
  • Soot (chimney-sweep crab).
  • Arsenic.
  • Immunosuppression (approx. 200 times higher risk).
  • Alcohol abuse, especially with high-proof spirits.
  • Smoking (tar distillates).

  • Leukoplakic, rough, painless, mostly exophytic, often hyperkeratotic, but sometimes also eroded plaques or nodules
  • In severe, horny hyperkeratosis one can speak of a Cornu cutaneum 
  • The verrucous carcinoma (Ackermann carcinoma) shows a plantar surface similar to warts
  • A metastasis occurs lymphogenically and later also hematogenically

  • Anamnesis with regard to predisposing factors.
  • Clinic.
  • Biopsy.
  • If the diagnosis is dermatopathologically confirmed, a full body inspection should be performed.
  • Palpation of the locoregional lymph nodes.
  • With tumour thickness of > 2mm à locoregional lymph node sonography.

  • 90% of all SCC is located in the head area
  • Rarer: oral mucosa, genital, toes, fingers

  • From the surface of the skin or the mucous membrane, finger-shaped, branching tumour strands infiltrate, destroying the basement membrane and growing deep into the tissue. 
  • The cells originate from the str. spinosum (ergo: spinocellular carcinoma). A cornified squamous epithelium with horny pearls (squamous eddies) is formed. Nuclear polymorphy, atypical mitoses, nuclear hyperchromasia, polyploidy, dyskeratosis, hyperkeratosis, cell atypia, mitoses, inflammatory infiltrate.
  • Immunohistological differentiation from basal cell carcinomas is carried out using Ber-EP4 markers.
  • Immunohistological differentiation from adnexal tumours is carried out using the cytokeratin marker CAM-5.2.

.

WHO classification as follows:

  • Spindle cell squamous cell carcinoma of the skin (aggressive behaviour).
  • Acantholytic (pseudoglandular) squamous cell carcinoma of the skin.
  • Verrucous squamous cell carcinoma of the skin (prognostically favourable).
  • Squamous cell carcinoma with horn formation.
  • Lymphoepithelioma-like squamous cell carcinoma of the skin.
  • The degree of differentiation according to Broders depends on the number of atypical, undifferentiated cells. 
  • Grade I <25%, grade II <50%, grade III <75%, grade IV >75%.
  • The higher the degree, the higher the metastatic tendency.

"High-risk spinocellular carcinoma" according to AJCC classification (2010):

  • Tumour thickness >2mm.
  • Penetration depth from Clark level 4.
  • Degree of de-differentiation from level III.
  • Perineural invasion.

  • Metastasis: ≤ 2 mm (0%), 2-6 mm (4%), > 6 mm (16%).
  • In case of metastasis the median survival time is 2 years.
  • Carcinomas of the penis, vulva and auricle tend to metastasise early. 
  • Aftercare: SOP currently being updated.

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