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This is a histologic subtype of squamous cell carcinoma that presents similar to other squamous cell carcinomas
  • Squamous cell carcinoma with foci of acantholysis within the epidermal component.

    Work-Up Considerations:

    • Diagnosis is made by histologic examination of skin biopsy specimen
    • Regional lymph node palpation for lymphadenopathy
    • Imaging studies and sentinel lymph node biopsy in cases of known or suspected metastasis
    • Identify and address precipitating factors, such as immunosuppression (due to drug or disease), acquired or genetic diseases with predisposition to developing skin cancers, chronic scarring/inflammatory conditions, and exposure to carcinogens.

    Treatment:

    • Sun protection, sun avoidance, daily broad spectrum sunscreen application (including sunscreen containing lip balms), and regular clinical follow-up should be advocated for all patients
    • Management should take into account various histologic and clinical risk factors, such as size of lesion, depth of invasion, presence of aggressive histologic features, anatomic location, occurence within a scar or in a site of chronic inflammatory process, whether the lesion is primary or recurrent, and additional factors, such as the patient?s immune status and neurologic symptoms
    • Primary treatment is surgical (surgical excision, Mohs? micrographic surgery)
    • For poor surgical candidates, other modalities such as radiation therapy, may be considered
    • Cryotherapy or curettage and electrodesiccation might be considered in superficial, low risk lesions in poor surgical candidates
    • For patients who are not able to undergo surgical extirpation or radiotherapy due to the high number of lesions or advanced disease stage, various local and systemic medical treatments might be considered as second or third-line options, but data is limited
    • Regardless of treatment, all patients should be regularly followed for recurrence
    • Oral retinoids may be used for prevention in immmunocompromised patients with multiple SCCs
    • Reduction, alteration (usage of sirolimus) or cessation of immunosuppressive therapy if feasible, in consultation with primary physician managing the patient?s immunosuppressive regimen.
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