Acute epithelioma--an aggressive squamous cell carcinoma of the skin

This report describes an aggressive squamous cell carcinoma of the skin for which we suggest the name acute epithelioma. It is frequently larger than 2 cm and has a characteristic morphology with raised, rolled, vascular but not everted edges. Commonly there is a central crust covering a foul discharge on a papilliferous base. The biopsy is characteristically ambiguous but often that of a well differentiated squamous cell carcinoma. Irrespective of the history, which is usually short, all tumors have a period of rapid growth. Among 193 patients with squamous cell carcinomas of the eyelids or external ear, 24 (12%) of the tumors were designated as being acute epitheliomas. For the eyelids 15/125 (12%) patients were in this group; 10 (67%) had tumors larger than 2 cm, five (33%) developed regional metastases, and three (20%) had tumor related deaths. Irradiation controlled the primary tumor in 15 (100%) patients. Among the 68 ear tumors, nine (13%) were called acute epitheliomas. Eight (89%) were larger than 2 cm, three (33%) developed regional metastases, and two (22%) patients had tumor related deaths. Irradiation controlled the primary tumor in seven (78%) patients. It is postulated that these acute epitheliomas are virus induced tumors that develop in actinicly damaged and immunologically suppressed skin. Following treatment, careful follow-up is recommended because of their metastatic and lethal potential.