A Case of Acantholytic Squamous Cell Carcinoma

Clinical and Dermoscopic Features of a Rare Histologic Variant: Acantholytic Squamous Cell Carcinoma

“…However, later it was accepted as an uncommon variant of squamous cell carcinoma [4]. It represents 2-4% of all cutaneous squamous cell carcinoma [5], and it is usually found on the sunexposed areas of elderly patients with notable male predominance [2]. However, an increased incidence of acantholytic SCC has been recorded in organ transplant patients [6].The lesions typically arise on the head and neck as a nodule or ulcer, particularly on and around the ears and face, de novo or may develop from an actinic keratosis [5], although other less-sun-exposed locations have been reported [1], including the vulva, penis, oral mucosa, nasopharynx, and breast [2].…”

“…Clinicaly, it presents as a nodular, flesh colored to red, scaling, crusted, and ulcerated lesion [1], with a slow growing pattern [5]. Therefore, histological examination is necessary for making the accurate diagnosis [2].Histological characteristics include typical squamous differentiation with discrete or diffuse areas of keratinocytic acantholysis with a pseudoglandular appearance [1]. In fact, the lesional keratinocytes show a variable degree of desmosomal disruption [3], resulting in rounded free-floating single cells or small clusters of cells [6], arranged in tubular and gland-like structures, which is referred to as a "pseudoglandular" appearance [2].…”

“…Moreover, at high-power field, we can identify the malignant criteria of cells, including voluminous, hyperchromatic and pleomorphic nuclei presenting atypical mitosis [5]. In immunohistochemistry, this tumor resembles the structure of eccrine neoplasms, but it is negative for dPAS, CEA and mucicarmine and it is only positive for EMA and cytokeratins [2].…”

“…The most frequent locations of the tumor are the sun exposed ones, however many other different sites have been reported [5]. The prognosis of ASCC is matter of debate [2], although it appears to behave more aggressively than non-acantholytic, welldifferentiated SCC [6]. We report a rare case of a 92 year old female patient presenting with an ASCC of the left cheek.…”

“…Acantholytic squamous cell carcinoma (ASCC) is an uncommon variant of squamous cell carcinoma (SCC) [1], in which significant portions of the neoplastic proliferation show a pseudoglandular or tubular microscopic pattern [2]. This variant is also known as adenoid SCC, adenoacanthoma of sweat glands, and pseudoglandular SCC [3], and few cases have been reported in literature [4].…”