Difference between revisions of "Suspected malignant skin excisions"

From patholines.org
Jump to navigation Jump to search
(Started)
 
(+Conditions)
Line 6: Line 6:
 
{{Skin fixation, minimal}}
 
{{Skin fixation, minimal}}
 
==Common targets==
 
==Common targets==
If suspected from the referral:
+
If directly suspected from the referral, see:
 
*[[Melanoma]]
 
*[[Melanoma]]
 
*[[Basal-cell carcinoma]]
 
*[[Basal-cell carcinoma]]
 
*[[Squamous-cell cancer of the skin]]
 
*[[Squamous-cell cancer of the skin]]
==Gross processing==
+
==Gross evaluation==
{{Gross processing of skin excisions|header==Gross processing=}}
+
Note:
 +
*Color
 +
<gallery>
 +
File:Dark skin focalities.jpg|link=Dark skin focalities|See separate article in case of '''[[dark skin focalities]]'''
 +
</gallery>
 +
*Well-defined or diffuse border
 +
*Size
 +
*Any elevation
 +
{{Gross processing of skin excisions|header=Tissue selection}}
 +
==Microscopic evaluation==
 +
Look for atypical cells. If found, look for:
 +
*Any pigmentation: Evaluate as [[dark skin focalities]].
 +
*Similarity to squamous cells: See below:
 +
 
 +
===Squamous cell-like proliferations===
 +
{|class="wikitable"
 +
|-
 +
! Condition<ref name="PaolinoDonati2017">Initially copied from: {{cite journal|last1=Paolino|first1=Giovanni|last2=Donati|first2=Michele|last3=Didona|first3=Dario|last4=Mercuri|first4=Santo|last5=Cantisani|first5=Carmen|title=Histology of Non-Melanoma Skin Cancers: An Update|journal=Biomedicines|volume=5|issue=4|year=2017|pages=71|issn=2227-9059|doi=10.3390/biomedicines5040071}}</ref> - "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)." !! Characteristics<ref name="PaolinoDonati2017"/> !!
 +
|-
 +
| [[Actinic keratosis]] || Atypical keratinocytes confined on basal layer.
 +
|-
 +
| Bowen || Atypical keratinocytes at every layer of epidermis.
 +
|-
 +
| Keratoacanthoma || Symmetrical and circumscribed proliferation of keratinocytes, with central horn plug, with epidermis that extends over the tumor. Highly differentiated SCC.
 +
|-
 +
| Invasive squamous cell carcinoma || Atypical and pleomorphic keratinocytes, involving the dermis and the sub-cutis with a potential metastatic spread.
 +
|-
 +
| Queyrat’s erytroplasia || As Bowen, but in the mucosa.
 +
|-
 +
| Adnexal carcinomas || Squamous differentiation, but does not show connection with the epidermis and highlights adnexal features.
 +
|-
 +
| Adenosquamous carcinoma || Mixed glandular and squamous differentiation.
 +
|-
 +
| Verrucous squamous cell carcinoma<ref group="notes>When present in ano-genital region, verrucous squamous cell carcinoma is also known with the term of Buschke–Löwenstein tumor</ref> || Exophytic squamous proliferation with marked papillomatosis and low atypia and the presence of koilocyte-like changes
 +
|-
 +
| Epithelioma cuniculatum || Squamous cell carcinomaof the foot. Histologically is characterized hyperkeratosis, acanthosis with an undulating, densely keratinized, well differentiated squamous epithelium, deeply penetrating the soft tissues.
 +
|-
 +
| Inverted follicular keratosis || Sharply circumscribed endophytic verrucous proliferation with prominent squamous features.
 +
|-
 +
| [[Seborrheic keratosis]] || Acanthosis, absence of atypia, pseudo-horn cysts, in inflamed lesions, mitoses may be present.
 +
|-
 +
| Bowenoid papulosis || Atypical keratinocytes and mitoses. Histology similar to Bowen’s disease.
 +
|-
 +
| Metastasis || Personal medical history of the patient, nodular proliferation without connection to epidermis, immunohistochemical evaluation.
 +
|}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 10:39, 23 October 2019

Author: Mikael Häggström [note 1]

Fixation

  • Generally: Buffered 4% formaldehyde.[1]

Common targets

If directly suspected from the referral, see:

Gross evaluation

Note:

  • Color
  • Well-defined or diffuse border
  • Size
  • Any elevation

Tissue selection

Gross pathologic processing of skin excisions[2][note 2]
Lesion size
<4 mm 4 - 8 mm 9 - 15 mm
Benign appearance

Tissue selection from skin excision with lesion less than 4 mm with benign appearance.png

Tissue selection from skin excision with lesion 4-8 mm with benign appearance.png

Tissue selection from skin excision with lesion 9-15 mm with benign appearance.png

Suspected malignancy Tissue selection from skin excision with less than 4 mm suspected malignant lesion.png Tissue selection from skin excision with 4-8 mm suspected malignant lesion.png Tissue selection from skin excision with 9-15 mm suspected malignant lesion.png

In table above, each top image shows recommended lines for cutting out slices to be submitted for further processing. Bottom image shows which side of the slice that should be put to microtomy. Dashed lines here mean that either side could be used. Further information: Gross processing of skin excisions

Microscopic evaluation

Look for atypical cells. If found, look for:

Squamous cell-like proliferations

Condition[3] - "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)." Characteristics[3]
Actinic keratosis Atypical keratinocytes confined on basal layer.
Bowen Atypical keratinocytes at every layer of epidermis.
Keratoacanthoma Symmetrical and circumscribed proliferation of keratinocytes, with central horn plug, with epidermis that extends over the tumor. Highly differentiated SCC.
Invasive squamous cell carcinoma Atypical and pleomorphic keratinocytes, involving the dermis and the sub-cutis with a potential metastatic spread.
Queyrat’s erytroplasia As Bowen, but in the mucosa.
Adnexal carcinomas Squamous differentiation, but does not show connection with the epidermis and highlights adnexal features.
Adenosquamous carcinoma Mixed glandular and squamous differentiation.
Verrucous squamous cell carcinoma[notes 1] Exophytic squamous proliferation with marked papillomatosis and low atypia and the presence of koilocyte-like changes
Epithelioma cuniculatum Squamous cell carcinomaof the foot. Histologically is characterized hyperkeratosis, acanthosis with an undulating, densely keratinized, well differentiated squamous epithelium, deeply penetrating the soft tissues.
Inverted follicular keratosis Sharply circumscribed endophytic verrucous proliferation with prominent squamous features.
Seborrheic keratosis Acanthosis, absence of atypia, pseudo-horn cysts, in inflamed lesions, mitoses may be present.
Bowenoid papulosis Atypical keratinocytes and mitoses. Histology similar to Bowen’s disease.
Metastasis Personal medical history of the patient, nodular proliferation without connection to epidermis, immunohistochemical evaluation.

Notes

  1. When present in ano-genital region, verrucous squamous cell carcinoma is also known with the term of Buschke–Löwenstein tumor
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. The excision examples show a normal mole (upper row, benign appearance) and a superficial basal cell carcinoma (lower row, suspected malignancy).

Main page

References

  1. Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-09.
  2. There are many variants for the processing of skin excisions. These examples use aspects from the following sources: ". Ochsner J 5 (2): 22–33. 2003. PMID 22826680. PMC: 3399331. Archived from the original. . 
    - With a "standard histologic examination" that, in addition to the lesion, only includes one section from each side along the longest diameter of the specimen.
    - It also shows an example of circular coverage, with equal coverage distance in all four directions.
    - The entire specimen may be submitted if the risk of malignancy is high.
  3. 3.0 3.1 Initially copied from: Paolino, Giovanni; Donati, Michele; Didona, Dario; Mercuri, Santo; Cantisani, Carmen (2017). "Histology of Non-Melanoma Skin Cancers: An Update ". Biomedicines 5 (4): 71. doi:10.3390/biomedicines5040071. ISSN 2227-9059. 

Image sources