Histologic Status of Squamous Cell Carcinoma In Situ After Diagnostic Biopsy in Immunocompetent and Immunosuppressed Patients. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Moioli, Eduardo K.; Hsieh, Clifford; Tisch, Angela; Bolotin, Diana
• Is Part Of: Dermatologic surgery. Volume 44:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: Skin -- Surgery -- Periodicals; Skin -- Diseases -- Surgery -- Periodicals; 617.477
• DOI: 10.1097/DSS.0000000000001300
• Languages: English
• ISSNs: 1076-0512

Abstract

Abstract : BACKGROUND: The histologic status of squamous cell carcinoma in situ (SCC-IS) after diagnostic biopsy has not been well described or compared between immunocompetent and immunosuppressed patients. Expression of immunohistochemical (IHC) markers of aggressive SCC has not been compared between SCC-IS that clears or becomes invasive after biopsy. OBJECTIVE: To determine the histologic status of SCC-IS after diagnostic biopsy in these populations. METHODS: Retrospective analysis of 129 patients with SCC-IS treated with excision and 55 patients treated with Mohs surgery. Histologic features of SCC in excised tissue after biopsy were recorded. Known SCC markers were evaluated using IHC. RESULTS: Invasive SCC was found in 3% to 16% of residual SCC-IS depending on surgical treatment modality. The history of skin cancer increased the odds of having invasive SCC in SCC-IS excisions (odds ratio 7.1, p < .05). Forty-seven percent of SCC-IS in immunosuppressed patients cleared after diagnostic biopsy compared with 70% in immunocompetent patients ( p < .05). Inflammatory infiltrate and molecular markers of aggressive SCCs (Ki-67, matrix metalloproteinase [MMP]-9, MMP-7, transforming growth factor-beta (TGFβ)-RI, TGFβ-RII, and Sox-2) were not predictive of residual or invasive SCC at the time of treatment. CONCLUSION: Up to 16% of SCC-IS showed invasive SCC at the time of surgical treatment. Immunosuppressed patients are more likely to have residual disease after biopsy. IHC markers of invasive SCC may not predict invasion.