[Desmoplastic squamous epithelial carcinoma of the skin and lower lip. A morphologic entity with great risk of metastasis and recurrence]

Abstract

The desmoplastic type of the squamous cell carcinoma (DSCC) of the skin is an entity which is readily distinguished by light microscopy. The DSCC has fine branches surrounded by a desmoplastic stroma and shows in some cases typical perineural, perivascular and widespread intradermal invasion (maximum 6 cm!). This type accounts for 8.2% (n = 44) of our collective of 594 squamous cell carcinomas (SCC) of the skin and vermilion border. Clinically DSCC look like other malignant epithelial tumors of the skin. All tumors were followed up for at least 3 years (maximum 10 years). The local recurrence rate was high (24.3%) even though micrographic surgery was carried out. The rate of local or regional metastasis was also very high (22.7%). In comparison the recurrence rate and the rate of metastasis of the remaining common 91.8% SCC's (n = 550) was low: 2.6% and 3.8%, respectively. The DSCC seems to be identical with the so called neurotropic SCC, the fine stranded SCC or the SCC with perineural invasion which have a high rate of local recurrence and metastasis as well, but DSCC is a better generic histopathologic term for the entire group. The DSCC is best treated with micrographic surgery and wider safety margins than any other type and should be followed up very frequently.