Knackstedt Thomas J, Brennick Jeoffry B, Perry Ann E, Li Zhongze, Quatrano Nicola A, Samie Faramarz H
Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Int J Dermatol. 2015 Jul;54(7):830-3. doi: 10.1111/ijd.12867. Epub 2015 Apr 27.
Squamous cell carcinoma (SCC) in situ may be transected in a superficial biopsy, which makes it difficult to distinguish between in situ and invasive carcinoma. This study investigated the frequency of invasive SCC in transected SCC in situ referred for Mohs surgery.
A retrospective chart review was performed to identify subjects with biopsy-proven, transected SCC in situ referred for Mohs surgery. The incidence of invasion, histologic variables, preoperative and intraoperative correlations, and clinical factors were determined and recorded.
Of 51 cases identified, five (9.8%) were found to harbor invasive SCC, 15 (29.4%) showed SCC in situ, and 28 (54.9%) showed evidence of scarring, inflammation, or actinic keratosis at the prior biopsy site. Invasive lesions required significantly more stages of Mohs surgery to obtain tumor clearance but were similar with regard to patient age, symptoms, and family and personal histories of skin cancer. Preoperative lesion size and duration were greater in invasive cases, but these differences did not reach statistical significance.
A small number of transected SCCs in situ, to which the caveat "invasion cannot be ruled out" can be applied, have an invasive component that is identified during Mohs surgery. Definitive treatment choices should depend on the physician's impression, the clinical characteristics of the lesion, tumor location, patient comorbidities, and patient desires.
原位鳞状细胞癌（SCC）在浅表活检时可能被切断，这使得区分原位癌和浸润性癌变得困难。本研究调查了因莫氏手术而转诊的被切断的原位SCC中浸润性SCC的发生率。
进行回顾性病历审查，以确定经活检证实为被切断的原位SCC且因莫氏手术而转诊的受试者。确定并记录侵袭发生率、组织学变量、术前和术中相关性以及临床因素。
在确定的51例病例中，5例（9.8%）发现有浸润性SCC，15例（29.4%）显示为原位SCC，28例（54.9%）在先前活检部位有瘢痕形成、炎症或光化性角化病的证据。浸润性病变需要更多阶段的莫氏手术才能清除肿瘤，但在患者年龄、症状以及皮肤癌家族史和个人史方面相似。浸润性病例的术前病变大小和持续时间更大，但这些差异未达到统计学意义。
少数被切断的原位SCC（可适用“不能排除浸润”的警示）存在浸润成分，在莫氏手术期间可被识别。明确的治疗选择应取决于医生的判断、病变的临床特征、肿瘤位置、患者合并症以及患者意愿。
