What does squamous cell carcinoma look like
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Visual and Histological Characteristics of Squamous Cell Carcinoma
Clinical Appearance of Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the second most common type of skin cancer, often presenting as a papule or nodule with varying degrees of hyperkeratosis and ulceration. These lesions typically arise on sun-exposed skin, particularly in elderly patients. The clinical manifestation of SCC can range from a precursor lesion known as actinic keratosis (AK) to more advanced forms such as squamous cell carcinoma in situ (SCCIS), invasive cSCC, and metastatic SCC.
Histological Features of Squamous Cell Carcinoma
Histologically, SCC is characterized by a proliferation of atypical keratinocytes that invade the dermis. These cells often form anastomosing cords and nests, displaying a glassy eosinophilic cytoplasm and enlarged nuclei. Mitotic figures, keratin pearls, and dyskeratotic keratinocytes are variably present, and intercellular bridges may be seen under higher magnification.
Variants of Squamous Cell Carcinoma
Adenoid Squamous Cell Carcinoma
Adenoid squamous cell carcinoma is a variant that can be mistaken for angiosarcoma due to its pseudovascular appearance. This type presents as a discrete cutaneous ulcer or crusted tan-pink nodule, primarily on sun-exposed areas of middle-aged or elderly patients. Microscopically, it features interanastomosing cordlike arrays of polygonal or flattened tumor cells with internal pseudolumina containing detached tumor cells.
Basaloid-Squamous Carcinoma
Basaloid-squamous carcinoma is another variant, often found in the mucosa of the tongue, hypopharynx, and larynx. It consists of small crowded cells with hyperchromatic nuclei and scant cytoplasm, forming small cystic spaces and foci of tumor necrosis. This variant is highly malignant, with a high rate of metastasis.
Diagnostic and Treatment Approaches
Diagnosis of SCC often involves a biopsy to confirm the presence of atypical keratinocytes and other histological features. Treatment typically includes surgical excision, with Mohs micrographic surgery being a preferred method due to its high cure rates and tissue-sparing benefits. Other treatment modalities include electrodessication and curettage, cryosurgery, radiotherapy, and systemic therapies for advanced cases .
Conclusion
Squamous cell carcinoma presents with a variety of clinical and histological features, ranging from superficial lesions like actinic keratosis to invasive and metastatic forms. Understanding these characteristics is crucial for accurate diagnosis and effective treatment. The histological diversity of SCC, including variants like adenoid and basaloid-squamous carcinoma, underscores the importance of thorough pathological examination and appropriate therapeutic strategies.
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