Squamous cell carcinoma of the skin

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify the subtypes of squamous cell carcinoma of the skin. 2. Identify factors that affect recurrence and/or metastasis. 3. Develop a surgical management plan for treating high-risk squamous cell carcinoma of the skin. In treating squamous cell carcinoma of the skin, a key concept in proper management is understanding why certain tumors are more prone to both recurrence and metastasis. When developing a surgical management plan, an understanding of "high risk" is essential. This article concentrates on identifying those tumor subtypes and factors that may serve as predictors of high-risk status as well as on providing management suggestions.     

Merkel cell carcinoma

Background

Merkel cell carcinoma (MCC) is an unusual primary neuroendocrine carcinoma of the skin. MCC is a fatal disease, and patients have a poor chance of survival. Moreover, MCC lacks distinguishing clinical features, and thus by the time the diagnosis is made, the tumour usually have metastasized. MCC mainly affects sun-exposed areas of elderly persons. Half of the tumours are located in the head and neck region.

Methods

MCC was first described in 1972. Since then, most of the cases reported, have been in small series of patients. Most of the reports concern single cases or epidemiological studies. The present study reviews the world literature on MCC. The purpose of this article is to shed light on this unknown neuroendocrine carcinoma and provide the latest information on prognostic markers and treatment options.

Results

The epidemiological studies have revealed that large tumour size, male sex, truncal site, nodal/distant disease at presentation, and duration of disease before presentation, are poor prognostic factors. The recommended initial treatment is extensive local excision. Adjuvant radiation therapy has recently been shown to improve survival. Thus far, no chemotherapy protocol have achieved the same objective.

Conclusion

Although rare, the fatality of this malignancy makes is important to understand the etiology and pathophysiology. During the last few years, the research on MCC has produced prognostic markers, which can be translated into clinical patient care.     

Squamous cell carcinoma of the lip

We reviewed 117 consecutive patients with squamous cell carcinoma of the lip. The retrospective review includes age, race, location, risk factors, TNM classification, histologic differentiation, treatment methods, recurrent disease, site of recurrence, and follow-up status. Results reveal prognosis is related to original tumor size, location, local recurrence, histologic grade, and presence of cervical metastasis. The presence of cervical lymph node disease reduces the survival from 90 to 50 percent; the survival after recurrent disease to the neck is 10 percent. When a prophylactic suprahyoid neck dissection shows involvement with tumor, 83 percent of patients have metastasis to cervical lymph nodes. The overall recurrence rate is 20 percent. Over 60 percent of the recurrent disease is due to tumors less than 4 cm in diameter. The local recurrence rate is 7 percent, but reexcision of the local recurrence gives a 75 percent cure rate. Aggressive surgical treatment is recommended for identifiably poor prognostic lesions and includes surgical excision, prophylactic suprahyoid neck dissection, and possible radical neck dissection.     

A transitional cell carcinoma cell line

Summary A transitional cell carcinoma cell line, COLO 232, was derived from a primary urinary bladder tumor in a Caucasian male. In culture, COLO 232 retained distinct uroepithelial phenotypic traits and produced both carcinoembryonic antigen and adrenocorticotropic hormone. COLO 232 had a chromosome mode of 58 and retained the X and Y chromosomes. Ten marker chromosomes were identified. COLO 232 will be of value for biochemical and immunological studies. Presented in part at the 28th Annual Meeting of the Tissue Culture Association, June 7, 1977. This work was supported by Grant No. CA 15018 awarded by the National Cancer Institute, DHEW, and the Mary B. and L. H. Marshall Fund.     

Immunohistochemical analysis for cell proliferation-related protein expression in small cell carcinoma of the esophagus; a comparative study with small cell carcinoma of the lung and squamous cell carcinoma of the esophagus

Small cell carcinoma is a rare neoplasm in the esophagus. To evaluate cell proliferation activity and its underlying mechanisms in this tumor, we examined immunohistochemically 5 cases of small cell carcinoma of the esophagus (SCCE) for expressions of tumor suppressor proteins, oncoproteins and cell proliferation markers including p53, p21WAF1/CIP1, retinoblastoma (Rb) protein, bcl-2, Ki-67 and PCNA, and compared the results with those of 5 cases of small cell carcinoma of the lung (SCCL) and 10 cases of squamous cell carcinoma of the esophagus (SQCE). The prevalence and labeling index of p53-immunoreactivity tended to be higher in SCCE (4/5; 56.6%) and SCCL (4/5; 79.9%) than in SQCE (6/10; 48.8%). Expression of p21WAF1/CIP1 was observed in 2 of 10 cases of SQCE. In contrast, its expression could not be detected in any cases of SCCE and SCCL examined. Expression of Rb protein was observed in 9 out of 10 cases of SQCE, but not in any cases of SCCE and SCCL. SCCE and SCCL showed more frequent and intense immunoreactivity for bcl-2 than SQCE. In expression of cell proliferation markers (Ki-67 and PCNA), no remarkable difference was observed among SCCE, SCCL and SQCE. These results suggest that SCCE and SCCL could share some genetic alternations including mutation of p53, loss of Rb gene and overexpression of bcl-2, and these may be related to the similar biological potentials between the two. Furthermore, SCCE was different from SQCE in expression of Rb protein and bcl-2, and these two types of esophageal carcinoma could arise through different molecular mechanisms.     

Differences between cell lines of uterine cervical glassy cell carcinoma and large cell nonkeratinizing squamous cell carcinoma.

Cell lines were established from two uterine cervical cancers, a glassy cell carcinoma (GCC) and a large cell nonkeratinizing squamous cell carcinoma (LCSC), and studied by a variety of techniques, including histology, chromosome analysis, heterotransplantation and tumor marker analyses. There were radical differences in the morphology, heterotransplantability, production of tumor markers, etc., between the cultures of these morphologically similar cancers. The LCSC line (HKMUS) consisted of polygonal and round cells containing tonofilaments; these cells discharged tumor antigen-4 (TA-4) into the conditioned media. HKMUS was heterotransplantable into the subcutis of nude mice to form LCSC. On the other hand, the GCC line (HOKUG) consisted of round or spindle-shaped cells. HOKUG was easily transplanted into the subcutis or intraabdominal cavity of nude mice and metastasized easily. It discharged TA-4, carbohydrate antigen 125 (CA125) and neuron-specific enolase (NSE) into the conditioned media. The histologic picture of GCC revealed numerous blood vessels and a rapid proliferation of the cells. GCC, which is considered to be a mixed carcinoma having the characteristics of both squamous carcinoma and adenocarcinoma, seems to be a cancer of unpredictable prognosis as compared to LCSC, possibly due to its rapid proliferation and easy metastasis, leading to peritonitis carcinomatosa.     

Renal cell carcinoma metastatic to the orbit

Metastatic lesions to the orbit, although rare, appear to be increasing in frequency. In a significant number of these patients, ocular signs and symptoms are the first indicators of their disease. Optometrists need to be aware of the clinical presentation, differential diagnosis, and indicated medical work-up in order to properly diagnose and manage this challenging group of patients.     

Squamous cell carcinoma of the parotid gland

Squamous cell carcinoma involving the parotid gland is an aggressive and rapidly advancing lesion which if not recognized and treated early will result in a high morbidity and mortality. We reviewed 30 patients with squamous cell carcinoma involving the parotid gland. Twenty-four patients had had previous epidermoid skin lesions in an area known to drain to the parotid gland and three resulted from direct extension into the gland from an overlying skin carcinoma, whereas only three were primary lesions of the gland. Patients who presented with involvement of the gland more than 4 months after excision of the skin lesion had a poor prognosis. Patients with epidermoid skin cancer in areas with a propensity to secondarily involve the parotid gland must be closely followed after treatment of the primary skin lesion.     

Nevoid basal cell carcinoma

The use of computer technology is becoming increasingly important in the handling of medical records. The cardiology data system used at The Hospital for Sick Children has greatly simplified the review and analysis of patient records. The methods of capturing data are logical and straightforward and have assisted fellows, residents and students in learning the systematic approach to the diagnosis of heart disease in children. The review of particular defects conducted as a research project has often led to further studies which have made important contributions to the knowledge of heart disease in childhood.     

Giant cell hepatocellular carcinoma

A terminal case of giant cell hepatocellular carcinoma, subsequent to Hepatitis B-associated macronodular cirrhosis is presented, illustrated and discussed. The uncommon finding of malignant ascites, in itself atypical of hepatocellular carcinoma, with an almost exclusive content of giant cells as the cellular component, was a feature of this unusual variant of hepatocellular carcinoma.     

Familial non-syndromic clear cell renal cell carcinoma

The diagnosis of familial non-syndromic clear cell renal cell carcinoma is one of exclusion. In families presenting with clear cell RCC a germline VHL mutation and a constitutional translocation of chromosome 3 must be excluded before familial non-syndromic clear cell RCC can be diagnosed. Large familial non-syndromic clear cell RCC kindreds are uncommon and a predisposing gene has not been identified. However inheritance is autosomal dominant in most cases and age at onset is earlier than in sporadic cases. Recognition and appropriate screening of familial non-syndromic clear cell RCC cases will reduce morbidity and mortality. Large scale collaborative linkage studies may provide a basis for the identification of familial non-syndromic clear cell RCC susceptibility gene(s).     

A transitional cell carcinoma cell line.

A transitional cell carcinoma cell line, COLO 232, was derived from a primary urinary bladder tumor in a Caucasian male. In culture, COLO 232 retained distinct uroepithelial phenotypic traits and produced both carcinoembryonic antigen and adrenocorticotropic hormone. COLO 232 had a chromosome mode of 58 and retained the X and Y chromosomes. Ten marker chromosomes were identified. COLO 232 will be of value for biochemical and immunological studies.     

Pathology and the evolutionary dynamics of clear cell renal cell carcinoma

Cancer is an ecosystem whose intrinsic mechanisms do not show up under the microscope of pathologists. However, the information provided by pathologists is absolutely necessary for the correct implementation of personalized treatments. This short paper seeks to analyze this apparent paradox, i.e. static snapshots for making crucial decisions in essentially dynamic diseases, taking clear cell renal cell carcinoma as a paradigmatic example of tumor variability. We seek to call the attention of pathologists and other cancer-related medical specialists to extend knowledge of the evolutionary features of the disease to help obtain a better understanding of why cancer behaves as it does.