Cutaneous squamous cell carcinomas consistently show histologic evidence of in situ changes: A clinicopathologic correlation,☆☆,

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Abstract

Squamous cell carcinoma on sun-damaged skin is a malignant neoplasm that evolves from its inception as squamous cell carcinoma in situ, which is commonly referred to as an actinic keratosis. In this study, we reviewed 1011 squamous cell carcinomas on sun-damaged skin and found that nearly 100% of these lesions contained histopathologic changes consistent with squamous cell carcinoma in situ at the periphery or within the confines of the squamous cell carcinoma. These malignant changes began in single layer areas of the lower epidermis and evolved into the epidermis and dermis. (J Am Acad Dermatol 1999;41:443-8.)

Section snippets

MATERIAL AND METHODS

In this study, we reviewed 1011 squamous cell carcinomas on sun-damaged skin retrieved from the files of Dermatopathology Laboratory, Inc, Indianapolis, Indiana, from July 1, 1996 to Nov 1, 1998. The lesions were obtained by excision or shave technique from 859 patients (572 men, 287 women); their ages ranged from 34 to 99 years (mean age, 75 years). The lesions were previously reviewed and diagnosed histopathologically by 3 dermatopathologists employed by the laboratory.

Initially, the lesions

RESULTS

Each of the 1011 previously diagnosed squamous cell carcinomas met the criteria for squamous cell carcinoma as defined previously. Further histopathologic examination showed that 983 of the 1011 specimens (97.2%) had changes consistent with squamous cell carcinoma in situ at the periphery or within the confines of the existing squamous cell carcinoma.

During our review, histologic evidence for the evolution of squamous cell carcinoma in situ into squamous cell carcinoma was clearly apparent.

DISCUSSION

The evolution of malignant neoplastic processes is well studied in all organ systems. However, there has been controversy related to the time a lesion should be considered malignant. In the field of dermatology, the evolution of squamous cell carcinoma, including its inception as squamous cell carcinoma in situ as a malignant process, has long been a firestorm of controversy. According to Leffell et al,1 actinic keratoses are the beginning of the cancer spectrum; the initial step in the process

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From the Dermatopathology Laboratory, Inc.

☆☆

Reprint requests: Robert M. Hurwitz, MD, Dermatopathology Laboratory, Inc, 9202 N Meridian St, Suite 215, Indianapolis, IN 46260.

0190-9622/99/$8.00 + 0   16/1/98970

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