Eimpunth Sasima, Goldenberg Alina, Hamman Michael Shane, Oganesyan Gagik, Lee Robert A, Hunnangkul Saowalak, Song Silvia Soohyun, Greywal Tanya, Jiang Shang I Brian
*Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; †Department of Dermatology, University of California, San Diego, Medical Center, La Jolla, California; ‡Compass Dermatopathology, La Jolla, California; §Department of Dermatology and Mohs Surgery, Southern California Permanente Medical Group, Fontana, California; ‖Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ¶Department of Dermatology, University of Pittsburgh Medical Center Health System, Pittsburg, Pennsylvania.
Dermatol Surg. 2017 May;43(5):698-703. doi: 10.1097/DSS.0000000000001028.
Shave biopsy may not be able to accurately distinguish squamous cell carcinoma in situ (SCCIS) from invasive squamous cell carcinoma (SCC). Information on the incidence of biopsy-proven SCCIS upstaged to SCC after a more complete histologic examination is limited.
To determine the incidence and clinical risk factors associated with upstaging the biopsy diagnosis of SCCIS into invasive SCC based on findings during Mohs micrographic surgery (MMS).
All MMS cases of SCCIS performed between March 2007 and February 2012 were identified, MMS operative notes were examined, and invasive dermal components were confirmed by the MMS slide review. Upstaged SCCIS was defined as biopsy-diagnosed SCCIS subsequently found to be an invasive SCC during MMS.
From 566 cases with the preoperative diagnosis of SCCIS, 92 (16.3%) cases were SCCIS upstaged to SCC. Location of ears, nose, lips, and eyelids, preoperative diameter >10 mm, and biopsy report mentioning a transected base were significant predictors of upstaged SCCIS.
Considering the possibility that over 16% of SCCIS may be truly invasive SCC, biopsy-proven SCCIS should be treated adequately with margin-assessed treatment modalities such as surgical excision or Mohs surgery when indicated.
削切活检可能无法准确区分原位鳞状细胞癌（SCCIS）与浸润性鳞状细胞癌（SCC）。关于经活检证实的SCCIS在更全面的组织学检查后被升级为SCC的发生率的信息有限。
根据莫氏显微外科手术（MMS）的结果，确定与将SCCIS的活检诊断升级为浸润性SCC相关的发生率和临床风险因素。
确定2007年3月至2012年2月期间所有进行的SCCIS的MMS病例，检查MMS手术记录，并通过MMS玻片复查确认真皮浸润成分。升级的SCCIS定义为活检诊断为SCCIS，随后在MMS期间发现为浸润性SCC。
在566例术前诊断为SCCIS的病例中，92例（16.3%）的SCCIS被升级为SCC。耳、鼻、唇和眼睑的部位、术前直径>10 mm以及活检报告提及基底横断是升级的SCCIS的重要预测因素。
考虑到超过16%的SCCIS可能实际上是浸润性SCC，经活检证实的SCCIS在有指征时应采用如手术切除或莫氏手术等评估切缘的治疗方式进行充分治疗。
