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Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification--part two.

David S Cassarino1, Damian P Derienzo, Ronald J Barr

  • 1Department of Pathology, Stanford University, Palo Alto, CA 94305, USA. dcassari@stanford.edu

Journal of Cutaneous Pathology
|April 25, 2006
PubMed
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A new classification system categorizes cutaneous squamous cell carcinoma (SCC) into low, intermediate, high, and indeterminate risk groups based on metastatic potential. This aids in predicting tumor behavior and guiding patient treatment.

Area of Science:

  • Dermatopathology
  • Oncology

Background:

  • Cutaneous squamous cell carcinoma (SCC) exhibits diverse clinical behaviors, from indolent to aggressive with metastatic potential.
  • Current classification often treats SCCs generically, lacking a system to stratify aggressiveness.
  • A definitive clinicopathological system for categorizing SCC aggressiveness is needed.

Purpose of the Study:

  • To propose a novel clinicopathological system for classifying cutaneous SCC based on malignant potential.
  • To stratify SCC subtypes into risk categories to improve prognostic accuracy.
  • To facilitate optimal patient treatment through risk-based subclassification.

Main Methods:

  • Categorization of SCC variants based on their established or estimated metastatic rates.
  • Defined risk categories: low (<=2%), intermediate (3-10%), high (>10%), and indeterminate.

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  • Included specific SCC subtypes within each risk category.

    • Main Results:

    • Low-risk SCCs: actinic keratosis-associated, HPV-associated, tricholemmal, spindle cell (non-radiation).
    • Intermediate-risk SCCs: adenoid, intraepidermal epithelioma with invasion, lymphoepithelioma-like.
    • High-risk SCCs: de novo, radiation/scar/immunosuppression-associated, invasive Bowen's, adenosquamous, malignant proliferating pilar.

    Conclusions:

    • The proposed risk-based classification system for cutaneous SCC provides prognostically relevant information.
    • Subclassification aids in distinguishing between indolent and aggressive tumor behaviors.
    • Integrating this system with factors like tumor size and invasion depth optimizes patient management.