Squamous Cell Epithelioma

Clinical features. Squamous Cell Epithelioma develops from the prickle cells of 'the epidermis. The tumor is characterized by rapid growth, early ulceration, and absence of the pearly nodule of the basal cell epithelioma, a prickle cell histopathology and a tendency to metastasize.

The sites of choice are the dorsal aspects of the hands, the face, the muco-cutaneous junctions and the mucous membranes of the mouth and the genitalia, though lesions can occur anywhere.

Epithelioma may arise as such, or may complicate dermatoses like keratosis, horn, leukoplakia, chronic ulcer, lupus vulgaris etc. The second mode of origin is more common than the first.

When it starts de novo, it is seen first as a nodule or a firm, thickened plaque which undergoes ulceration within a few weeks. The ulcer is well-defined with an indurated, everted border. The base is granular, papillomatous or even fungating and is covered by a crust. Sometimes one may come across a cauliflower-like tumor. The lesion bleeds easily when the epithelioma complicates a primary condition; in such cases the precancerous lesion shows rapid growth, signs of inflammation, induration and ulceration as evidence of malignant change.

The regional lymph glands may show enlargement due to metastases. Hence, they should always be palpated. Metastases usually occur within 6-12 months.

Pathology: It is characterized by marked hyperplasia of the polygonal, eosinophilic-staining prickle cells in irregular masses in the corium, cell nests and inflammatory reaction. The epidermal cells show abundant mitoses. The histopathological features are helpful in deciding about the degree of malignancy (grading).

Occasionally, it can be difficult to distinguish pseudo-epitheliomatous hyperplasia from early squamous cell epithelioma.

Course: It is rapid and extends over weeks and months. It is locally destructive to the cartilages, bones and other structures like, for instance, the eyes. First, the metastases occur in the regional lymph glands, and later there is dissemination to the other glands and by blood stream to the other viscera.

Diagnosis of Squamous Cell Epithelioma

It is based upon:

• A fast-growing lesion in a person past middle-age.
• (2) The presence of precancerous dermatosis.
• (3) An ulcer with an indurated border, everted margins and a granular base.
• (4) Biopsy and histopathological features.

Differential diagnosis of Squamous Cell Epithelioma

It is made mainly from basal cell epithelioma, keratoacanthoma and tertiary syphilides. For details, see under basal cell epithelioma. Mixed types of baso-squamous cell epitheliomas do occur; this intermediate variety can be recognized through the microscope. When in doubt, it is a good principle to excise and examine histopathologically. Penile warts can sometimes cause confusion.

Prognosis of Squamous Cell Epithelioma

It is fair if the case is diagnosed early. .The outlook becomes poor once the metastases have occurred. Deep lesions, adherent and destructive lesions, and lesions on the mucous membranes or the muco-cutaneous junctions have grave prognosis.

Treatment of Squamous Cell Epithelioma

It varies with the individual. X-ray therapy (3,600 r to 6,000 r) in divided doses and wide surgical excision are the two known methods of treatment used. In advanced cases, regional lymph glands should be excised. Exact treatment, however, should only be undertaken after there has been a consultation between a dermatologist, surgeon and pathologist. Mohs' chemosurgery or electro-surgery gives good results in expert hands.