Cassarino David S, Derienzo Damian P, Barr Ronald J
Department of Pathology, Stanford University, Palo Alto, CA 94305, USA.
J Cutan Pathol. 2006 Apr;33(4):261-79. doi: 10.1111/j.0303-6987.2006.00516.x.
Cutaneous squamous cell carcinoma (SCC) includes many subtypes with widely varying clinical behaviors, ranging from indolent to aggressive tumors with significant metastatic potential. However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (< or = 2% metastatic rate), intermediate (3-10%), high (greater than 10%), and indeterminate behavior. Low-risk SCCs include SCC arising in actinic keratosis, HPV-associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate-risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma-like carcinoma of the skin. High-risk subtypes include de novo SCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear-cell SCC. Subclassification of SCC into these risk-based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients.
皮肤鳞状细胞癌（SCC）包括许多临床行为差异很大的亚型，从惰性肿瘤到具有显著转移潜能的侵袭性肿瘤。然而，病理学家和临床医生都倾向于将所有鳞状上皮肿瘤统称为普通SCC。目前尚未颁布基于侵袭性将皮肤SCC分为不同类别的权威、全面的临床病理系统。因此，我们根据SCC变体的恶性潜能提出了以下分类，将它们分为低风险（转移率≤2%）、中风险（3%-10%）、高风险（>10%）和行为不确定四类。低风险SCC包括光化性角化病中发生的SCC、人乳头瘤病毒相关的SCC、毛鞘癌和梭形细胞SCC（与放疗无关）。中风险SCC包括腺样（棘层松解性）SCC、伴有侵袭的表皮内上皮瘤和皮肤淋巴上皮瘤样癌。高风险亚型包括原发性SCC、与易感因素（放疗、烧伤瘢痕和免疫抑制）相关的SCC、侵袭性鲍温病、腺鳞癌和恶性增殖性毛囊肿瘤。行为不确定类别包括印戒细胞SCC、滤泡性SCC、乳头状SCC、附件囊肿中发生的SCC、鳞状小汗腺导管癌和透明细胞SCC。将SCC细分为这些基于风险的类别，同时列举其他因素，包括肿瘤大小、分化程度、浸润深度和神经周围浸润，将提供与预后相关的信息，并有助于为患者制定最优化的治疗方案。
