Petter G, Haustein U F
Department of Dermatology, University of Leipzig, Germany.
J Eur Acad Dermatol Venereol. 1998 Jul;11(1):37-44.
Owing to the rising incidence of tumours, the question of reliable risk classification is becoming increasingly significant.
Participation in the multicentre carcinoma registry maintained by the Association of Operative and Oncological Dermatology of the German Dermatological Society requires, in addition to the parameters of clinical staging and grading already established by the International Union against Cancer, description of other histopathological criteria related to prognosis, with special attention to microstaging.
One hundred and eighty-four patients with squamous cell carcinoma of the skin were examined. The histological parameters, carcinoma type, Breslow index, invasion level, growth form, grading and mitotic index were recorded and classified, and clinical staging was performed.
It was found that the clinical criterion of tumour diameter (T-category) determines the further course of the disease. The other parameters taken into account, namely pathohistological microstaging and grading, can increase the accuracy of prognosis evaluation, and in particular enable carcinomas of the T1-category to be classified as either high malignant or low malignant tumours. The desmoplastic squamous cell carcinoma subtype is a potential risk tumour. Endophytic tumours are more malignant in their development than exophytically-growing carcinomas, and the probability of recurrence and metastatic tumour spread further increases when ulceration can be detected by microscope. In order to distinguish metastatic and recurring carcinomas, in addition to determining the invasion levels after Clark, measuring the Breslow index proved to be an important criterion. Quoting the mitotic index augmented the grading system, which further improved the reliability of malignancy assessment.
The TNM categories currently applied to squamous cell carcinomas of the skin must be supplemented by additional histological parameters which, according to our findings, permit more accurate classification of high and low malignant tumours.
由于肿瘤发病率不断上升，可靠的风险分类问题变得越来越重要。
参与由德国皮肤病学会手术与肿瘤皮肤病学协会维护的多中心癌瘤登记，除了国际抗癌联盟已经确定的临床分期和分级参数外，还需要描述其他与预后相关的组织病理学标准，尤其要关注微分期。
对184例皮肤鳞状细胞癌患者进行检查。记录并分类组织学参数、癌瘤类型、布雷斯洛指数、浸润水平、生长形式、分级和有丝分裂指数，并进行临床分期。
发现肿瘤直径的临床标准（T类别）决定了疾病的进一步发展过程。所考虑的其他参数，即病理组织学微分期和分级，可以提高预后评估的准确性，特别是能将T1类癌瘤分为高恶性或低恶性肿瘤。促结缔组织增生性鳞状细胞癌亚型是一种潜在的风险肿瘤。内生性肿瘤在发展过程中比外生性生长的癌瘤更具恶性，当显微镜下可检测到溃疡时，复发和转移性肿瘤扩散的可能性会进一步增加。为了区分转移性和复发性癌瘤，除了确定克拉克分级后的浸润水平外，测量布雷斯洛指数被证明是一个重要标准。引用有丝分裂指数增强了分级系统，进一步提高了恶性程度评估的可靠性。
目前应用于皮肤鳞状细胞癌的TNM分类必须补充其他组织学参数，根据我们的研究结果，这些参数可以更准确地对高恶性和低恶性肿瘤进行分类。
