Squamous cell carcinoma

From dermoscopedia

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Author(s) Florentia Dimitriou · Teresa Deinlein · Iris Zalaudek
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Status update May 14, 2017
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Squamous cell carcinoma (SCC) is the second most common cutaneous malignancy after Basal Cell Carcinoma with an increasing incidence worldwide. It usually arises on sun-exposed areas of the skin, such as scalp, face, neck, forearms and dorsal hands.


Invasive squamous cell carcinoma[edit]

Invasive SCC appears often clinically as papulonodular, plaque-like, papilomatous or exophytic.




Dermoscopy criteria

  • Central mass of keratin: amorphous, yellow-white to light-brown areas without any recognizable structure
  • Targetoid hair follicles: keratotic plugs within follicular openings of the skin, mostly over a white structureless area
  • Ulceration: large irregularly shaped or roundish areas of dull red or red-brown structureless color



Vascular architecture

  • Herpin vessels: vascular loops, usually surrounded by whitish halo
  • Linear-irregular vessels (serpentine): linear or slightly curved, irregularly shaped, sized and distributed red structures


SCC fig1.JPG SCC fig2.JPG


Other vascular patterns, such as dotted and glomerular (coiled) vessels may also be present. Combinations of these vascular morphologies result in the so-called polymorphous pattern.

Poorly differentiated SCCs are dermoscopically typified by a predominantly red color, resulting from the presence of bleeding and dense vascularity. On the other hand, white colored criteria (central mass of keratin, whitish halos and structureless whitish areas) are associated with well- or moderately differentiated variants.




Progression model of actinic keratosis to squamous cell carcinoma
Invasive SCC often arises in association with actinic keratosis (AK). The progression model of AK to SCC suggests an initial transition from a red pseudonetwork ("strawberry pattern") to an increasing neovascularization (development of clustered dotted/glomerular vessels). The follicles gradually miniaturize and disappear, whereas hairpin and linear-irregular vessels appear. Along with these vascular changes, a central mass of keratin forms and ulceration may occur.

Pigmented invasive squamous cell carcinoma[edit]

Pigmented invasive SCC is rare variant of SCC. Dermoscopically, it reveals a diffuse, homogeneous blue pigmentation with distinct, irregularly distributed, blue-gray granular structures. If ulcerated, dark brown to black crusts are visible. Due to the pigmentation, vessels are usually not seen.




References

  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
  2. Argenziano, G., Zalaudek, I., Corona, R., et al., 2004, Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol, 140, 1485–9.
  3. Felder S., Rabinovitz H., Oliviero M., Kopf A., 2006, Dermoscopic differentiation of a superficial basal cell carcinoma and squamous cell carcinoma in situ. Dermatol Surg, 32, 423–5.
  4. Kittler, H., Riedl, E., Rosendahl, C. & Cameron, A., 2008, Dermatoscopy of unpigmented lesions of the skin: a new classification of vessel morphology based on pattern analysis. Dermatopathol Pract Conc, 14, 4.
  5. Kreusch, J. & Koch, F., 1996, Auflichtmikroskopische Charakterisierung von Gefassmustern in Hauttumoren. Hautarzt, 47, 264–72.
  6. Kreusch, J.F., 2002, Vascular patterns in skin tumors. Clin Dermatol, 20, 248–54.
  7. Zalaudek, I., Giacomel, J., Schmid, K., et al., 2012, Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: a pro- gression model. J Am Acad Dermatol, 66, 589–97.