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. 2017 Feb;76(2):327-333.
doi: 10.1016/j.jaad.2016.09.024. Epub 2016 Nov 23.

Acantholytic squamous cell carcinoma is usually associated with hair follicles, not acantholytic actinic keratosis, and is not "high risk": Diagnosis, management, and clinical outcomes in a series of 115 cases

Toru Ogawa  1 , Maija Kiuru  2 , Thomas H Konia  2 , Maxwell A Fung  3
Affiliations

Acantholytic squamous cell carcinoma is usually associated with hair follicles, not acantholytic actinic keratosis, and is not "high risk": Diagnosis, management, and clinical outcomes in a series of 115 cases

Toru Ogawa et al. J Am Acad Dermatol. 2017 Feb.

Abstract

Background: Acantholytic squamous cell carcinoma (aSCC) is regarded as a high-risk variant of cutaneous squamous cell carcinoma (SCC). Acantholytic actinic keratosis (aAK) has been regarded as a precursor risk factor for aSCC. However, supporting evidence is limited.

Objective: We sought to document clinical features, histologic features, management, and outcomes in a series of aSCC cases.

Methods: Definitions of aSCC, aAK, and aSCC arising in association with aAK were applied to a consecutive series of aSCC cases. Clinical characteristics and outcomes were obtained from electronic medical records.

Results: Of 115 aSCC cases (103 patients, mean age 71.8 years), actinic keratosis was present in 23% (27/115) but only 7.8% (9/115) exhibited associated aAK. Ten cases (10/115, 9%) fulfilled strict histologic criteria for follicular SCC as previously defined, but 50 of 115 (43%) of our aSCC cases exhibited predominant involvement of follicular epithelium rather than epidermis. Clinical outcome (median follow-up, 36 months) was available in 106 of 115 (92%). One patient experienced regional extension (parotid), and 1 patient experienced a local recurrence (nose). No disease-related metastases or deaths were documented.

Limitations: This was a single-institution retrospective study from the United States.

Conclusions: The presence of acantholysis in cutaneous SCC does not specifically confer aggressive behavior, a finding that may inform clinical practice guidelines.

Keywords: acantholysis; acantholytic actinic keratosis; cutaneous oncology; dermatopathology; follicular squamous cell carcinoma; nonmelanoma skin cancer; outcomes; prognosis; squamous cell carcinoma.

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Figures

Fig 1
Fig 1
Acantholytic squamous cell carcinoma, follicular type. The tumor involves follicular epithelium but not epidermis. (Hematoxylin-eosin stain; original magnification: ×20; inset, ×100.)
Fig 2
Fig 2
Acantholytic squamous cell carcinoma with features of keratoacanthoma. The tumor is mostly composed of large keratinocytes with abundant pale eosinophilic (glassy) cytoplasm. Acantholysis is present. (Hematoxylin-eosin stain; original magnification: ×20; inset, ×100.)
Fig 3
Fig 3
Acantholytic squamous cell carcinoma (aSCC), follicular pattern. The tumor is centered upon follicular epithelium but also involves epidermis. Some features of actinic keratosis (parakeratosis, basilar epidermal atypia) are present; by our definition, this example did not qualify for aSCC arising in association with actinic keratosis because there is invasive carcinoma in the directly underlying dermis. (Hematoxylin-eosin stain; original magnification: ×20; inset, ×100.)
Fig 4
Fig 4
Acantholytic squamous cell carcinoma (SCC) with associated acantholytic actinic keratosis (aAK). aAK exhibiting parakeratosis, atypical basilar keratinocytes with suprabasilar acantholytic clefting, sparing of adnexal epithelium, severe solar elastosis, and absence of directly underlying SCC. (Hematoxylin-eosin stain; original magnification: ×20; inset, ×100).
See this image and copyright information in PMC

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