Intramural Metastatic Squamous Cell Carcinoma of Stomach

Intramural metastasis to the stomach (IMMS) from carcinoma esophagus, excluding direct invasion and spread to the stomach, is relatively uncommon. Diagnosis of IMMS is based on histological criteria, and it is associated with poor prognosis (Takubo et al. Cancer 65:1816–1819, 1990]. We report two patients of SCC oesophagus in whom intramural metastasis to stomach has occurred.     

Management of High-Risk Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma is an increasing public health concern, representing the second most common cancer in the United States. High-risk cutaneous squamous cell carcinoma represents a subgroup of this disease, where patients are at higher risk of metastasis and death. To date, there are no accepted criteria for defining or managing these patients. This review discusses the current state of knowledge of high-risk cutaneous squamous cell carcinoma and outlines reasonable management strategies based on available data.Cutaneous squamous cell carcinoma (CSCC) is the second most common cancer in the United States, with an excess of 200,000 new cases each year.¹ Although CSCC can usually be cured by a variety of techniques, there are still an estimated 8,000 cases of nodal metastasis and 3,000 deaths in the United States annually, almost wholly attributable to a subset designated as aggressive or high-risk CSCC, which has substantially higher rates of recurrence and metastases.^2,3 Ideal management has not yet been defined for this group, there are no prognostic models that reliably predict individuals at risk for recurrence and metastasis, and there is a lack of randomized controlled trials (RCTs) for the treatment of high-risk CSCC. Subsequently, management of patients is not uniform.⁴ The aim of this article is to discuss the current state of knowledge of high-risk CSCC, highlight gaps in this knowledge, and outline reasonable management strategies based on available data.     

皮肤鳞状细胞癌的研究进展

皮肤鳞状细胞癌是黑素瘤之外导致皮肤肿瘤患者死亡的首要病因。皮肤鳞状细胞癌的发病机制至今尚不明确,限制了相关分子靶向治疗的发展。目前,临床上对该病的治疗仍以手术治疗为主,辅以放射治疗等其他手段。本文结合文献对其相关研究进展进行综述。     

Molecular Profile of Advanced Cutaneous Squamous Cell Carcinoma

BACKGROUND: Patients with advanced cutaneous squamous cell carcinoma (cSCC) frequently have high tumor mutation burdens (TMBs) but cannot tolerate immunotherapy due to comorbid conditions or already immunosuppressed states. OBJECTIVE: We considered whether these patients might be good candidates for targeted therapy if unique genetic mutations are identified. METHODS: Biopsies of primary tumors or metastases of advanced cSCC from seven patients were sent for FoundationOne testing. Genomic alterations and TMBs were compiled from these samples and used to tailor therapy when possible. Patients were followed for changes in their disease burden. RESULTS: Eight biopsies taken from seven patients were sent for FoundationOne testing. Sixty-three genomic alterations were identified. Thirteen genes had mutations occur more than once, with mutations in TP53 being the most frequently identified (100% of patients). In one patient, an ERBB3 mutation was identified, and lapatinib was added to nivolumab for a six-month course of treatment, after which point the patient experienced stabilization of disease without progression for two years as of the most recent follow-up. CONCLUSION: More routine investigation of cSCC tumors with next-generation sequencing can help to identify unique mutations that respond favorably to targeted therapy in these notoriously difficult-to-treat malignancies.     

Imiquimod: An Effective Alternative for the Treatment of Invasive Cutaneous Squamous Cell Carcinoma

BACKGROUND: Some patients with invasive cutaneous squamous cell carcinoma are either not adequate surgical candidates or present with lesions in cosmetically sensitive areas in which a surgical procedure might result in an apparent and/or a cosmetically unacceptable scar. OBJECTIVE: To evaluate the effectiveness of imiquimod 5% cream in the treatment of an invasive squamous cell carcinoma in the nose of a young man. METHODS: Imiquimod 5% cream was applied to the lesion five times a week for 12 weeks. RESULTS: Complete clinicopathologic tumor clearance and an excellent cosmetic result were achieved after 12 weeks of imiquimod treatment. CONCLUSION: Imiquimod 5% cream may represent a reasonably effective alternative for the management of invasive squamous cell carcinoma in selected patients.     

Invasive Cutaneous Squamous Cell Carcinoma Associated with Actinic Keratosis

BACKGROUND: It is suggested that most squamous cell carcinomas in sun-exposed areas arise from preexisting solar keratosis. Actinic keratosis is thought of as being a precursor to squamous cell carcinoma. This form of squamous cell carcinoma has been considered to be a relatively benign lesion. We report a case of invasive squamous cell carcinoma associated with actinic keratosis leading to orbit destruction and meningeal infiltration. OBJECTIVE: To demonstrate that well-differentiated tumors can act extremely aggressively with the potential toward infiltrative growth patterns. METHODS: Histologically controlled surgery along with multiple radiation therapy was performed. RESULTS: The tumor progressed inducing perineural invasion, orbit infiltration, osseous destruction, and meningeal invasion. CONCLUSION: The association of squamous cell carcinoma and actinic keratosis supports the concept of a causal relation. Excision with histologic examination of actinic keratosis seems to be useful for accurate diagnosis. Squamous cell carcinoma can represent an aggressive tumor with infiltrative growth pattern and should not be considered a benign lesion.     

皮肤鳞状细胞癌的中医药治疗进展

皮肤鳞状细胞癌是具有发病率高、发展快、可转移、易误诊等特点的一种恶性肿瘤,对人类的健康造成威胁。随着中医的发展和现代医学实验研究技术的进步,中医药在皮肤鳞状细胞癌的现代研究方面也取得一定成果。目前临床上治疗鳞状细胞癌多采取手术及药物化疗等,因不良反应的存在,患者接受度低。中药具有多靶点、安全性高、不良反应少等优势,在治疗皮肤鳞状细胞癌中中医具有一定优势,本文将围绕中药单体、中药复方,以及针灸在治疗皮肤鳞状细胞癌的研究进展展开论述和思考。     

Histologic Subtyping and Malignancy Assessment of Cutaneous Squamous Cell Carcinoma

BACKGROUND: Squamous cell carcinomas (SCCs) of the skin have a wide range of histologic subtypes and there are indications of differences in prognosis. OBJECTIVE: The morphologic variety of SCCs with respect to its biological behavior and the further course of disease is analyzed, with emphasis on histopathologic criteria, briefly quoting the main clinical and pathogenetic aspects. METHODS: Referring to the international tumor classification of the World Health Organization, histologically different carcinoma variants are presented and discussed, based on a review of the literature regarding each subtype, and also including the desmoplastic SCC type. RESULTS: Histologically, common invasive SCCs are most frequently found, while metastases mainly occur in tumors of high thickness and poor differentiation. The immature spindle cell carcinoma type resembles sarcoma and may grow rapidly with an aggressive clinical course. Lymphoepithelioma-like carcinoma of the skin is extremely rare and its histogenesis remains to be elucidated. Thus far, one case with metastasis and lethal outcome has been reported. As details determining the progression ability have so far only been scanty and partially contradictory, more investigations are necessary, especially for acantholytic SCCs and invasive SCCs developing from Bowen's disease, whereas verrucous carcinomas can be categorized as low malignancy neoplasms. Desmoplastic SCCs, especially with large tumor thickness, should be separated from other SCC subtypes due to their high risk of local recurrence and metastatic spread. CONCLUSION: The future outcome of SCCs of the skin is significantly influenced by their histologic grade and tumor thickness. In addition, subtyping represents another valuable histopathologic tool for improving the assessment of malignancy.     

Head and Neck Squamous Cell Carcinoma Metastatic to the Orbital Apex

Primary squamous cell carcinoma of the head and neck most commonly metastasizes to the lymph nodes, lung, bone, and liver. Many other rare sites of metastatic disease have been reported. To date, metastatic squamous cell carcinoma of the head and neck to the orbital apex has not been described. Presented are two cases, one tonsil and one parotid primary with metastatic disease to the orbital apex. Many tumors have been found to metastasize to the eye and orbit, but head and neck neoplasms are rarely reported. A review of the literature is presented in addition to the detailed case reports with their radiologic findings and clinical course. Surgical resection followed by postoperative radiotherapy appears the treatment of choice at this time.     

Risk of Basal Cell and Squamous Cell Carcinoma in Persons with Prior Cutaneous Melanoma

BACKGROUND: Melanoma has been associated with an overall increase in actinic tumors, including actinic keratoses, as well as with noncutaneous malignancies. OBJECTIVE: Determine the risk of developing basal cell and squamous cell skin cancer in patients with prior cutaneous melanoma (actinic keratoses not encountered). METHODS: This retrospective study included 1396 white patients with prior cutaneous melanoma followed at the Roswell Park Cancer Institute in the period 1977-1978. The control group was the white population of the Detroit area in the same period (1977-1978). RESULTS: A total of 25 patients (18 males, 7 females) developed 35 basal cell and/or squamous cell carcinomas: 18 developed basal cell carcinomas, 2 squamous cell carcinomas, and 5 both. The calculated odds ratio was 3.49 (males 3.67, females 2.86, 95% confidence interval 1.52-8.00). No correlations were found with age, type, anatomic site, and length of follow-up of cutaneous melanoma. CONCLUSION: A history of cutaneous melanoma significantly increases the risk of basal cell and squamous cell skin cancer.     

Metastatic Squamous Cell Carcinoma Resembling Cellulitis and Osteomyelitis of the Fifth Toe

Statistically, metastasis of carcinomas to pedal phalanges is rare. However, true to all bone metastases of the body, its presence is associated with a very poor prognosis. A case of metastatic sinonasal squamous cell carcinoma to the fifth toe is presented followed by a review of the literature.     

Myocardial Metastasis of Cutaneous Squamous Cell Carcinoma in a Renal Transplant Recipient

Myocardial metastasis from a cutaneous squamous cell carcinoma (SCC) is rare. Herein we have presented a case of metastasis from cutaneous SCC to the myocardium in a renal transplant recipient, which was confirmed by a cardiac fine-needle biopsy. Postmortem examination revealed disseminated metastatic disease involving myocardium, lungs, thyroid, skin, and peritoneum secondary to cutaneous SCC likely related to immunosuppression. At 46 years of age, he received a renal transplant for chronic renal failure caused by chronic glomerulonephritis. He started to develop multiple nonmelanoma skin cancers 4 years later. At least 23 invasive SCCs and 14 basal cell carcinomas were excised. His immunosuppressive regimen consisted of cyclosporine (150 mg), azathioprine (75 mg), and prednisone (10 mg daily), which was not modified despite multiple nonmelanoma skin cancers. Our case report further illustrates the potentially aggressive and fatal nature of cutaneous SCCs that can develop in organ transplant recipients. It argues for modification of the immunosuppressive regimen in such patients. The management of renal transplant patients with nonmelanoma skin cancers remains difficult and complex.     

Squamous Cell Carcinoma Antigen in Psoriasis: An Immunohistochemical Study

BackgroundSquamous cell carcinoma antigens (SCCA1, SCCA2) are members of the ovalbumin serpin family that have been described as biomarkers of squamous cell carcinomas. Different studies to date have stated the involvement of SCCA in the pathogenesis of certain immunological diseases, such as asthma and atopic dermatitis.ObjectiveWe sought to assess the expression of SCCA2 in the skin of patients with chronic plaque psoriasis and to detect its correlation with the clinical severity of psoriasis and with the density of inflammatory infiltrates in the skin lesions.MethodsSkin biopsies were taken from 24 patients with psoriasis vulgaris and 24 healthy controls by 5-mm punches. Tissues were stained with hematoxylin and eosin to confirm the diagnosis and to assess the grade of inflammation. The expression level of SCCA2 in the skin was assessed by immunohistochemical analysis.ResultsThe tissue SCCA2 level was significantly higher in psoriatic patients than controls and correlated positively with the severity of psoriasis. In addition, the dermal SCCA2 expression correlated positively with the density of dermal inflammatory infiltrates.ConclusionSCCA2 could be a useful marker of the clinical severity and the grade of inflammation of psoriasis.     

Periocular Squamous Cell Carcinoma

BACKGROUND We present a case report of periocular squamous cell carcinoma and a review of the literature with emphasis on early diagnosis, proper follow-up and management, reconstructive options, and new immunomodulatory therapies.
OBJECTIVE The objective is to guide the dermatologist and the dermatologic surgeon in proper management and continued care of patients with periocular squamous cell carcinoma in light of its propensity for perineural involvement and regional lymphatic metastases.
MATERIALS AND METHODS A MEDLINE, Ovid, and PubMed search was conducted for recent relevant articles pertaining to periocular,periorbital,squamous cell carcinoma, and their surgerytreatment modalities.
CONCLUSIONS Periocular squamous cell carcinoma is an aggressive tumor, characterized by perineural involvement and an overall rate of regional lymph node metastases reported to range from 10% to as high as 20% to 25%. Increased vigilance must be undertaken when treating these high-risk tumors. Mohs micrographic surgery or excision with frozen section analysis is the standard of care for periocular squamous cell carcinoma. Multiple options exist for the reconstruction of the postoperative defect that allow for excellent function and cosmesis. Finally, research into new immunomodulators will hopefully lead to an increased understanding of the aggressive nature of periocular squamous cell carcinoma and potential aid in the treatment of the tumor.     

Approach to Metastatic Carcinoma of Unknown Primary in the Head and Neck: Squamous Cell Carcinoma and Beyond

Metastatic carcinoma to cervical lymph nodes presenting as an unknown primary is quite common. In most cases, the primary site is ultimately identified. Carcinomas that remain of unknown primary after a thorough search are uncommon. This review will focus on those cases that initially present as unknown primaries, since this is the setting in which pathologists first encounter these cases and in which they play an important role in guiding patient management. Most are squamous cell carcinomas, the majority of which are human papillomavirus (HPV)-related and originate in the palatine tonsils and base of tongue. HPV-related oropharyngeal squamous cell carcinomas are increasing in incidence and have unique clinical and pathologic features that make them particularly likely to present as an unknown primary. Understanding these features has led to improved detection of the primary tumors. Further, even when the primary tumor is not found, prognosis is very dependent on characterization of the tumor HPV status. Papillary thyroid carcinomas may also initially present without a known or clinically detectable primary, either as a neck mass or incidentally in a neck dissection performed for another indication. The latter is a very indolent disease. Finally, primary salivary gland carcinomas may mimic an unknown primary and need to be distinguished from cutaneous metastases to the parotid gland, which may present without a recognized skin tumor. Here, we review the clinical and pathologic features of these entities and provide a systematic approach to their diagnosis.     

Fluorodeoxyglucose Positron Emission Tomography in Cutaneous Squamous Cell Carcinoma: Retrospective Analysis of 12 Patients

BACKGROUND: Whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used for whole-body imaging modality in detecting malignancy in clinical oncology. However, only a few reports of FDG PET in skin cancers have been described, except for melanoma and lymphoma. OBJECTIVE: To report on the usefulness of FDG PET as a baseline workup study for patients with cutaneous squamous cell carcinoma (SCC). METHODS: There were 12 cases of SCC (9 cases with high-risk SCC). Of the 12, FDG PET was performed for staging in 11 patients and for restaging in 1 patient 1 year after wide excision. RESULTS: Primary lesions were detected in nine cases (83.3%), lymph node involvement in three cases (25.0%), and distant. organ (lung) involvement in one case (8.3%). In one patient whose primary lesion was positive, stomach cancer with involvement of adrenal glands, omentum, and lymph nodes was incidentally detected. All of the patients with high-risk SCC showed FDG uptakes of the primary lesions, and the patients with FDG uptakes in lymph nodes and distant organ had high-risk SCC. CONCLUSION: There have been no comparative studies on the cost-effectiveness between sentinel lymph node biopsy and FDG PET in SCC patients. However, considering the noninvasiveness and thoroughness in checking the whole body, including distant organs, FDG PET may have clinical value as a baseline workup study for patients with high-risk SCC.