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Acantholysis in SCC Not Considered High Risk

J Am Acad Dermatol; ePub 2016 Nov 23; Ogawa, et al

The presence of acantholysis in cutaneous squamous cell carcinoma (SCC) does not specifically confer aggressive behavior, a recent study found. Researchers sought to document clinical features, histologic features, management, and outcomes in a series of acantholytic SCC (aSCC) cases. Definitions of aSCC, acantholytic actinic keratosis (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. They found:

  • Of 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.
  • 10 cases (10/115, 9%) fulfilled strict histologic criteria for follicular SCC as previously defined, but 50 of 115 (43%) of the 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.

Citation:

Ogawa T, Kiuru M, Konia TH, Fung MA. 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. [Published online ahead of print November 23, 2016]. J Am Acad Dermatol. doi:10.1016/j.jaad.2016.09.024.

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