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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.


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.