Acantholytic invasive squamous cell carcinoma: tumor diameter, invasion depth, grade of differentiation, surgical margins, perineural invasion, recurrence and death rate

Abstract

Acantholytic SCC were more likely to be located on head sites with less median depth than non-acantholytic SCC. Increasing percentage of acantholysis within acantholytic SCC was not associated with a shift towards poor differentiation. Histologic margins of 1.2 mm may adequately excise small acantholytic SCC. No recorded deaths, low PNI and low recurrence rates suggests acantholytic SCC is low-risk.

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

“…Of the articles investigated, the recurrence and metastasis rates ranged from 6% to 10%to 2%, to 43%, respectively, which is comparable to data published for regular SCC [1]. Furthermore, to date, there is no uniform evidence that acantholytic SCC is more aggressive than non-acantholytic SCC [6].…”

“…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].…”

“…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].…”

“…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.…”

Squamous cell carcinoma: pain as a clue to increased tumour diameter, increased invasion depth, the grade of differentiation, acantholysis and perineural invasion

“…Other authors have questioned the higher‐risk status of acantholytic SCC . One recent study found early acantholytic SCC to be low risk without an increased rate of disease‐caused death . A recent systematic review of cutaneous SCC risk factors found that PNI indicates a significant risk for recurrence, metastasis and disease‐specific death.…”