Cutaneous Squamous Cell Carcinoma (CSCC) One Year Experience of a Single Dermatopathology Service at a University Based Academic Medical Center
RK Virk, R Han, A Deng. UMass Memorial Hospital, Worcester, MA
Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common non-melanocytic skin cancer and the incidence is on the rise. Although the prognosis for CSCC is usually excellent, a small subset of tumors do recur, metastasize, and even cause death. It is thus crucial to accurately identify the subset of CSCC patients at risk for poor outcomes.
Design: We reviewed all the CSCC cases from a single dermatopathology service of an academic medical center during the period of July 2007 to June 2008.
Results: Our findings are: 1) Of the total 15,000 specimens, 1421 were diagnosed as squamous cell tumors (approximately 9 %). Among all squamous cell lesions, 54% (n=763) were squamous cell carcinoma in-situ (SCCIS) and 46% (n=661) were invasive squamous cell carcinomas. 2) Among the invasive CSCC, 53.4% (n=353) cases were present on the head and neck; 40% (n=263) were from the extremities, 9.5% (n=62) cases on the ear; and the trunk counted only for < 7% cases. 3) The mean age of invasive CSCC was 76 years (range 40-100 years) which was similar to mean age for in-situ lesions (mean age- 74 yrs). Overall male to female ratio was 2:1. However, poorly differentiated CSCC showed 9:1 male to female ratio, significantly different from overall ratio. 4) Most invasive carcinoma cases were well differentiated (WD) (71%, n=470), followed by moderately differentiated (MD) (20%, n=129), and then poorly differentiated (PD) (3%, n=20). Still, some were difficult to classify (6%, n=42). 5) 69% CSCC on the head and neck were well differentiated, whereas moderately differentiated and poorly differentiated accounted for 26% and 5% respectively. The distribution of WD, MD and PD CSCCs on the extremities was: 78%, 13% and PD 2% respectively. Head and neck region had more proportion of poorly differentiated CSCCs relative to extremities. 6) The degree of differentiation was reversely associated with the possibility of having multiple skin cancers: PD 25% > MD 13% >WD 4% respectively. 7) 11% of all CSCCs cases were associated with coexisting basal cell carcinoma (BCC). However, we did not find any correlation between the degree of differentiation of CSCCs and presence of BCC.
Conclusions: The head and neck regions had more proportion of poorly differentiated CSCC which are associated with multiple skin cancers.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 60, Wednesday Morning