Figure - available from: Journal of Skin Cancer
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Pseudoepitheliomatous hyperplasia featuring acanthotic squamous epithelium showing irregular thick finger-like downgrowths into the underlying dermis. (H&E, ×20).
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Squamous cell carcinoma (SCC) is a common and important primary cutaneous malignancy. On skin biopsies, SCC is characterized by significant squamous cell atypia, abnormal keratinization, and invasive features. Diagnostic challenges may occasionally arise, especially in the setting of small punch biopsies or superficial shave biopsies, where only pa...
Citations
... Cutaneous squamous cell carcinoma (cSCC) has several clinical and histopathologic mimics that can present a diagnostic challenge [1]. Not all histologically diagnosed SCCs should be treated with surgery, and clinical pathologic correlation is essential when making a diagnosis and developing a treatment plan. ...
... Several diagnoses share histopathologic features with cSCC, including benign reactive conditions and other cutaneous malignancies. Therefore, an accurate diagnosis is essential to prevent unnecessary surgery for patients [1,2]. While immunohistochemistry can help differentiate cSCC from non-squamous etiologies, it is difficult to distinguish between conditions associated with squamous proliferation. ...
Background Correctly identifying cutaneous squamous cell carcinoma (cSCC) mimickers can be both clinically and histopathologically challenging. We present a series of patients with biopsy-proven cSCCs for whom multiple surgeries were avoided by assessing the clinical situation, recognizing an alternative diagnosis that pathologically mimics cSCC, and prescribing appropriate therapy for the underlying condition. Methodology Seven female patients presented for treatment of biopsy-proven cSCC affecting the lower leg. After further investigation, we observed that these women shared similar characteristics, including age ranging from the 5th to the 9th decade, often experiencing stress, exhibiting associated pruritus with diverse causes, having few or no previous skin cancers, and generally showing minimal photodamage. Results In all cases, surgery was deferred and patients demonstrated complete clinical response to therapies directed toward an alternative diagnosis. Repeat biopsies of treated lesions revealed no evidence of cSCC. Conclusions Not all histologically diagnosed cases of cSCC should be treated with surgery, and each patient should be worked up thoroughly to evaluate for an alternative diagnosis. Possible clinical and histologic cSCC mimickers include allergic contact dermatitis (ACD), stasis dermatitis, hypertrophic lichen planus (LP), and drug eruption, among others. In the described population, pruritic papules on the lower leg should prompt further investigation to prevent the morbidity associated with unnecessary surgery.
... It is a known fact that atypical mitoses, lymphovascular invasion, and perineural invasion are never seen in PEH, and dyskeratosis is an exceedingly rare phenomenon in PEH. Two of these features, i.e., Atypical mitoses and dyskeratosis, are of value even on small biopsies (21)(22)(23). Nonetheless, exceptional difficulty may be encountered in differentiating the above two in small biopsies, and immunohistochemistry for p53, Matrix metalloproteinase 1, and E-cadherin have been found to be useful (24). In one of the case series from the same institute (2007), five cases of histoplasmosis were reported, which had clinically presented as carcinoma involving the oral cavity (3 cases), hypopharynx (1case), and larynx (1 case). ...
Objective:
Histoplasmosis is a systemic, deep mycotic infection caused by Histoplasma capsulatum. Disseminated histoplasmosis (DH) is synonymous with HIV seropositive immunocompromised individuals; however, isolated histoplasmosis involving the head and neck mucosal sites mimicking malignancy is a clinical predicament. The result, in a superficial biopsy with marked pseudoepitheliomatous hyperplasia (PEH), in a tertiary care cancer center where the number of squamous carcinomas far outnumber the infectious diseases, could be catastrophic.
Material and method:
The archives of a tertiary care cancer hospital were searched (2010-2019) for cases of histoplasmosis involving the head and neck mucosal sites in HIV non-reactive patients.
Results:
Six cases of isolated head and neck histoplasmosis were seen in biopsies from 4 men and 2 women, with an age range of 46-72 years. Three of these patients suffered from chronic illnesses. The most common site involved was the larynx (vocal cords) in three cases, two cases were involving lips, and one involving the tongue. The biopsies were reviewed in-house with a clinical diagnoses of malignancy in all and an outside biopsy diagnosis of "squamous cell carcinoma" in 2 cases. The important histological findings in the biopsy were PEH (3 cases), granulomas (2 cases), lymphoplasmacytic inflammation (all cases). Eosinophils were conspicuous by their absence. Intracellular histoplasma was seen in all cases, albeit to varying density, which was confirmed with GMS stain.
Conclusion:
A high index of suspicion, meticulous history taking by oncologists, and appropriate distinction of PEH from neoplastic squamous proliferation by pathologists in superficial biopsies and an apropos deeper wedge biopsy are essential to clinch the correct diagnosis.
... Many clinical and histopathological mimickers of squamous cell carcinoma (SCC) have been described in the literature including hypertrophic lichen planus, tophaceous gout, and keratoacanthomas [1][2][3]. While SCC often requires invasive and costly interventions to optimize patient outcomes, many SCC mimickers are benign and require minimal treatment, highlighting the importance of correct diagnoses prior to unnecessary interventions. ...
... Dermatologic and Mohs micrographic surgeons often encounter lesions where the clinical presentation does not match the histopathological description or vice versa. Given there are histopathological and clinical mimickers in Mohs micrographic surgery (MMS) [1][2][3], surgeons must have a low threshold for re-biopsy when the clinicopathologic correlation (CPC) seems inconsistent. A clinical suspicion for further evaluation prior to surgery may result in avoidance of inappropriate surgical therapy for non-operative conditions. ...
Misdiagnosing granuloma annulare (GA) for a malignant process can lead to unnecessary and costly treatment avenues for the patient. Thus, it is salient for surgeons to independently evaluate a patient's clinical and histopathologic presentation before proceeding with surgery. We present a case of a 67-year-old male with a biopsy-proven squamous cell carcinoma (SCC) on the dorsal hand who presented for Mohs micrographic surgery (MMS). At this time, the surgeon noticed the histopathologic diagnosis did not match the patient's clinical appearance. GA was diagnosed following a repeat biopsy of the lesion, which prevented an unnecessary Mohs procedure. We present this case primarily to highlight the importance of clinicopathologic correlation by the surgeon when a patient is referred for surgery.
... Keratoacanthoma (KA) is defined as a benign keratinocytic neoplasm which arises from human's hair follicle. There may be a seasonal variation in the appearance of keratoacanthoma which suggests that ultraviolet rays have a strong effect on tumor development, but they may develop on parts of the body not exposed to sunlight [1]. ...
... Occasionally multiple keratoacanthomas appear, or a single lesion that extends for more than a few centimeters. These variants are resistant to treatment [1,2]. ...
Keratoacanthoma is a benign epithelial tumor with favorable evolution which poses a considerable problem of differential diagnosis with squamous cell carcinoma. we report the case of a patient who presented an unusual location of this tumor, causing an essentially diagnostic and aesthetic problem, it is a large keratoacanthoma taking the central part of the lower lip which appeared two months previously and increasing in size suddenly and which required surgical, diagnostic and therapeutic ablation in order to eliminate the risk of squamous cell carcinoma in situ. postoperative treatment was simple but at the cost of a visible scar that can be improved by a combination of aesthetic techniques.
... 13 On the other side, it shoud not be forgotten, that, although most SCC cases are readily diagnosable, some challenges are occasionally encountered, as SCC could present a wide variety of histopathologic features and and small biopsy specimens which reveal only part of the lesion. 14,15 At last, another important aspect is the causal association between leishmaniasis and malignancy suggested both in animals and in humans. In these cases, infection may play a significant role, directly or indirectly, in the pathogenesis and prognosis, through numerous pathophysiological cascades, paving the way for mutations and the development of skin cancer. ...
American cutaneous leishmaniasis (ACL) should be differentiated from traumatic ulcers, venous ulcers, tropical ulcer, lower limb ulcers due to sickle cell anemia, pyodermatitis, paracoccidioidomycosis, syphilis, cutaneous neoplasms, among others.1 Histopathology may be suggestive, but it is rarely specific enough to make the diagnosis without identification of the amastigote forms of the parasite.2 Among the non-specific alterations to the histopathological examination, pseudoepitheliomatous hyperplasia (PEH) presents as a challenge, especially in the differential diagnosis with squamous cell carcinoma (SCC).
... It is encountered as clinically sporadic, solitary lesion showing rapid growth over four to five weeks and then resolving after six months (Aksoy B et al., 2017). Numerous studies have investigated the differences between KA and SCC in terms of cellular proliferation, apoptosis and cell cycle, and histomorphological regulation of molecules (Tan et al., 2013) Tan et al., 2013;Putti et al., 2004;Hodak et al., 1993). Since the beginning of use of BRAF inhibitor treatment for melanoma and hedgehog pathway inhibitor treatment for advanced basal cell carcinoma, the incidence of KA has increased (Bell et al., 2015;Sarah et al., 2015). ...
... It is encountered as clinically sporadic, solitary lesion showing rapid growth over four to five weeks and then resolving after six months (Aksoy B et al., 2017). Numerous studies have investigated the differences between KA and SCC in terms of cellular proliferation, apoptosis and cell cycle, and histomorphological regulation of molecules (Tan et al., 2013) Tan et al., 2013;Putti et al., 2004;Hodak et al., 1993). Since the beginning of use of BRAF inhibitor treatment for melanoma and hedgehog pathway inhibitor treatment for advanced basal cell carcinoma, the incidence of KA has increased (Bell et al., 2015;Sarah et al., 2015). ...
Objective: Mutations in genes encoding proteins along the RAS-RAF-MEK-ERK pathway have been detected in a variety of tumor entities, including malignant melanoma, thyroid, colon, over carcinomas and some sarcomas. The increased activity of BRAF V600E leads to downward signalization activation via mitogen-activated protein kinase (MAPK), which plays an important role as cell growth, differentiation and survival regulator. Latest data show BRAF undergoes mutation in nearly 7% of cancers and this situation makes BRAF another important oncogene in this pathway. We aimed to evaluate the relationship between keratacanthoma and BRAF expression.Methods: 28 cases of keratocanthomas were included in this study. Sections were taken from the selected blocks with a thickness of 3 microns with poly-lysine coating. BRAF antibody was applied to the tissues. The obtained preparations were evaluated by light microscopy. It was rated according to the degree of staining in epidermis.Results: Areas showing cytoplasmic staining with BRAF were evaluated in sections. It was observed that there was no staining in the keratocanthomas, and staining in sebaceous glands and sweat glands in peripheral basal cells. It was also noted that the sweat glands had more stain than the sebaceous glands. The cases included 18 males and 10 females with ages varying from 33 to 85 years. The duration of the lesions was between one month and one year. Lesion dimensions varied from 5 to 70 mm, with mean size of 21 mm. There were 14 cases (50%) with head and neck localization, and 14 cases (50%) with localization other than the head and neck.Conclusion: As a result, it has been concluded that BRAF mutation may not be involved in keratoacanthoma.
... The narrow biological relationship among several SPSs may complicate the successful diagnosis of skin cancer. Certain researches have pointed out the difficulty in discerning among specific SPSs from the clinical, histological and molecular points of view: AK vs SCC [9], AK and SCC vs PRIMEL [10], SCC vs BCC and MSC [11], primary MCC (PMCC) vs metastatic MCC (MMCC) [12], etc. Different editions of the American Joint Committee on Cancer (AJCC) have gradually introduced the most outstanding clinical parameters for their diagnosis This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ ...
Many clinical studies have revealed the high biological similarities existing among different skin pathological states. These similarities create difficulties in the efficient diagnosis of skin cancer, and encourage to study and design new intelligent clinical decision support systems. In this sense, gene expression analysis can help find differentially expressed genes (DEGs) simultaneously discerning multiple skin pathological states in a single test. The integration of multiple heterogeneous transcriptomic datasets requires different pipeline stages to be properly designed: from suitable batch merging and efficient biomarker selection to automated classification assessment. This work presents a novel approach addressing all these technical issues, with the intention of providing new sights about skin cancer diagnosis. Although new future efforts will have to be made in the search for better biomakers recognizing specific skin pathological states, our study found a panel of 8 highly relevant multiclass DEGs for discerning up to 10 skin pathological states: 2 healthy skin conditions a priori, 2 cataloged precancerous skin diseases and 6 cancerous skin states. Their power of diagnosis over new samples was widely tested by previously well-trained classification models. Robust performance metrics such as overall and mean multiclass F1-score outperformed recognition rates of 94% and 80%, respectively. Clinicians should give special attention to highlighted multiclass DEGs that have high gene expression changes present among them, and understand their biological relationship to different skin pathological states.
... A careful search for a possible ongoing infective process should be done with examination of deeper levels and use of microbiological special stains. 11 Hematoxylin and eosin microscopic evaluation and clinico-pathologic correlation remain the gold standard in reaching the correct diagnosis. 1 The major management challenge for this patient was that of decision making by the parents who felt the child was too little to undergo surgery to excise the wound and graft. ...
Introduction: Pseudoepitheliomatous hyperplasia is a benign condition characterized by hyperplasia of the epidermis and adnexal epithelium commonly occurring in reaction to several conditions including chronic burn wound. Case Report: An 18 month old male patient presented with scald burns to the scalp and face with chronicity and infection of the burn wound as consent for skin grafting was not given by the parents. Initial histology of incision biopsy specimen revealed a well-differentiated squamous cell carcinoma in a chronic burn wound on the scalp. This did not correlate with the clinical picture of the wound necessitating a second histologic review of the biopsy specimen, which this time was confirmed as pseudoepitheliomatous hyperplasia. Patient further declined excision and grafting with the wound eventually healing with scarring after 10 months. Conclusion: A very high index of suspicion is required in making the diagnosis of PEH. Public enlightenment is needed to educate people on wounds and their management if optimal results must be obtained.
... It is common practice to excise lesions suspicious for skin cancer without prior histological confirmation. Several mimickers of nonmelanoma skin cancer, mostly benign tumors, have been described in the literature [4]. ...
Brunsting-Perry pemphigoid is a rare autoimmune blistering skin disease. Similar to nonmelanoma skin cancers, Brunsting-Perry pemphigoid has a predilection for the head and neck. Herein, a case of solitary Brunsting-Perry pemphigoid treated as cutaneous squamous cell carcinoma (SCC) with subsequent excision is reported.
... The overlying epidermis tends to show only reactive features or be ulcerated by the growth of the subjacent tumour. 11 Prognosis of penile SCC with metastases in HIVpositive patients depends on the stage of presentation and should be treated aggressively. Treatment of penile carcinoma remains difficult due to its aggressive nature and a paucity of data. ...
The incidence of penile squamous cell carcinoma (SCC) varies widely in different parts of the world. It is rare in Western countries but common in developing countries like India. The glans and foreskin are the most commonly affected sites. It can occur in two forms which have different evolution and prognosis. Exophytic papillary lesions have late and rare lymphatic spread and ulcero-infiltrating lesions are associated with rapid lymph node invasion and a poorer prognosis. Human immunodeficiency virus (HIV) is an aggravating factor for penile cancer and accelerates the progression of the disease. Cutaneous metastasis from penile SCC is rarely reported. Here, we report a case of metastatic SCC of the penis in a 51-year-old HIV-infected man who presented with cutaneous metastases in the inguino-pubic region with a hidden penile SCC.
