Manstein C H, Frauenhoffer C J, Besden J E
Division of Plastic Surgery, St. Mary Medical Center, Langhorne, PA, USA.
Ann Plast Surg. 1998 May;40(5):469-72. doi: 10.1097/00000637-199805000-00004.
Keratoacanthoma of the skin and well-differentiated squamous cell carcinoma are two cutaneous neoplasms that most often occur in sun-exposed sites of light-skinned persons. It is often difficult to distinguish these two from each other either clinically or histologically. The view that these two cutaneous neoplasms are part of the same disease entity is not new. We reviewed 150 patients with these two diseases in an effort to see whether any specific criteria for diagnosis and treatment could be achieved. It is our hypothesis that they are not separate diseases but within the spectrum of the same disease. Keratoacanthoma may be some sort of aborted malignancy or hyperplastic premalignant lesion within the squamous cell carcinoma spectrum. The incidence of metastases from squamous cell carcinoma of the skin may be as high as 3%. We do not have the courage to wait 3 months to see if a potentially invasive and metastatic neoplasm is indeed involutional. Incision biopsy may be wrought with significant histopathological inconsistencies. We believe that early, complete excision is the treatment of choice for all skin neoplasms thought to be keratoacanthoma.
皮肤角化棘皮瘤和高分化鳞状细胞癌是两种最常发生在浅肤色人群阳光暴露部位的皮肤肿瘤。无论是在临床上还是组织学上，这两者常常难以区分。这两种皮肤肿瘤属于同一疾病实体的观点并不新鲜。我们回顾了150例患有这两种疾病的患者，试图确定是否能得出任何诊断和治疗的具体标准。我们的假设是，它们并非独立的疾病，而是同一疾病范围内的不同表现。角化棘皮瘤可能是某种鳞状细胞癌谱系内的恶性肿瘤未遂或增生性癌前病变。皮肤鳞状细胞癌的转移发生率可能高达3%。我们没有勇气等待3个月来观察一个潜在的侵袭性和转移性肿瘤是否真的会自行消退。切开活检可能会出现显著的组织病理学不一致情况。我们认为，对于所有被认为是角化棘皮瘤的皮肤肿瘤，早期完整切除是首选的治疗方法。
