Acantholytic squamous cell carcinoma is usually associated with hair follicles, not acantholytic actinic keratosis, and is not “high risk”: Diagnosis, management, and clinical outcomes in a series of 115 cases

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• 作者：Toru Ogawa ; MD ; PhD^a ; Maija Kiuru ; MD ; PhD^a ; ^b ; Thomas H. Konia ; MD^a ; ^b ; Maxwell A. Fung ; MD^a ; ^b ; ^{maxfung@ucdavis.edu}
• 关键词：acantholysis ; acantholytic actinic keratosis ; cutaneous oncology ; dermatopathology ; follicular squamous cell carcinoma ; nonmelanoma skin cancer ; outcomes ; prognosis ; squamous cell carcinoma
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：76
• 期：2
• 页码：327-333
• 全文大小：1329 K
• 卷排序：76

文摘

Acantholytic squamous cell carcinoma (aSCC) is regarded as a high-risk variant of cutaneous squamous cell carcinoma (SCC). Acantholytic actinic keratosis (aAK) has been regarded as a precursor risk factor for aSCC. However, supporting evidence is limited.ObjectiveWe sought to document clinical features, histologic features, management, and outcomes in a series of aSCC cases.MethodsDefinitions of aSCC, aAK, and aSCC arising in association with aAK were applied to a consecutive series of aSCC cases. Clinical characteristics and outcomes were obtained from electronic medical records.ResultsOf 115 aSCC cases (103 patients, mean age 71.8 years), actinic keratosis was present in 23% (27/115) but only 7.8% (9/115) exhibited associated aAK. Ten cases (10/115, 9%) fulfilled strict histologic criteria for follicular SCC as previously defined, but 50 of 115 (43%) of our aSCC cases exhibited predominant involvement of follicular epithelium rather than epidermis. Clinical outcome (median follow-up, 36 months) was available in 106 of 115 (92%). One patient experienced regional extension (parotid), and 1 patient experienced a local recurrence (nose). No disease-related metastases or deaths were documented.LimitationsThis was a single-institution retrospective study from the United States.ConclusionsThe presence of acantholysis in cutaneous SCC does not specifically confer aggressive behavior, a finding that may inform clinical practice guidelines.