Squamous cell carcinoma

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Classification according to ICD-10
C80.9 Malignant neoplasm, unspecified
ICD-10 online (WHO version 2019)

Squamous cell (English Squamous cell carcinoma ), also called squamous cell carcinoma , spinalioma , prickle cell cancer , spinocellular epithelioma or squamous referred to are of the epithelia of the skin and the mucous membranes outgoing malignant ( malignant ) tumors from the group of carcinomas . You can also by other tissues out, which themselves have no squamous epithelia but with the ability to Plattenzellmetaplasieto have. Squamous cell carcinoma is the second most common malignant skin tumor.

Localizations

Squamous cell carcinoma occurs predominantly in areas of the body that are naturally covered by squamous epithelium . This includes the outer skin and mechanically more stressed mucous membranes such as the oral cavity, throat, vocal folds, esophagus, vagina, cervix and anal region. Furthermore, squamous cell carcinomas can also occur in other places via the squamous epithelial metaplasia, e.g. B. in the lungs.

causes

Squamous cell carcinomas of the skin develop primarily on the floor of severely photodamaged skin with pre-existing actinic keratoses . In rarer cases, they arise from chronic wounds, burn scars or other skin diseases. The saree cancer among Indian women, for example, triggered by constant irritation of the skin by the traditional clothing. Squamous cell carcinoma of the skin is the prime example of a tumor caused by sunlight. The cumulative sun exposure ("UV lifetime account") obviously plays a decisive role here. People who have a weakened immune system as a result of drug therapy after organ transplants are particularly at risk.

Antibiotics from the group of fluoroquinolones are photo- genotoxic substances with clastogenic properties which, according to animal experiments, cause benign and malignant skin tumors, especially squamous cell carcinomas, in combination with UVA radiation. Clinical observations suggest that fluoroquinolones such as ciprofloxacin can induce highly aggressive, metastatic, and recurrent squamous cell carcinoma, especially in long-term treatment of immunocompromised patients. Damage to DNA repair proteins and mitochondria are discussed as the pathophysiological cause of fluoroquinolone-induced skin lesions .

Squamous cell carcinomas of the cervix uteri, but also of the ENT tract and other body regions are partly HPV -associated and develop via precancerous stages.

Squamous cell carcinoma of the lungs and upper respiratory tract can be caused by smoking.

pathology

Highly differentiated invasive squamous cell carcinoma. HE.
p16 immunohistochemistry. Brown coloring of the precancerous stage on the left in the picture.
Extensive squamous cell carcinoma of the cervix uteri with light gray tumor mass.
Nodular spinalioma of the skin
Ulcerative spinalioma of the skin
Ulcerative spinalioma of the mucous membrane

Squamous cell carcinomas grow wart-like ( verrucous ) or ulcerating and mimic the keratinizing or non-keratinizing squamous epithelium to different extents. A cytoskeleton made of cytokeratin (CK) is typical for them . Highly differentiated carcinomas of this entity keratinize and, since the horny scales lie inside the tumor and cannot be peeled off, horn spheres (horn beads) layered like onion skin, which can usually be clearly diagnosed microscopically . Poorly differentiated carcinomas lose the ability to form horns. They form very polymorphic (multiform), solid tumors. Very strongly dedifferentiated ( anaplastic ) squamous cell carcinomas can look like sarcomas in the spindle cell ( fusiform ) variant .

Squamous cell carcinomas are considered invasive and therefore capable of metastasis if they have broken through the basement membrane . In most cases, a desmoplastic stromal reaction (reactive connective tissue) can also be detected. Other signs of invasion include invasion of blood and lymph vessels, perineural sheath invasion, destructive growth, and metastasis.

Non-invasive cancer precursors are called squamous cell dysplasia, intraepithelial neoplasia (IEN) or squamous intraepithelial lesion (SIL) and are classified according to severity. Carcinoma in situ (Cis) is synonymous with severe dysplasia or high grade IEN / SIL. Mild dysplasias can regress spontaneously; in severe dysplasias, the transition to invasive carcinoma is possible at any time.

Immunohistochemically , squamous cell carcinomas usually show reactivity with antibodies against the nuclear markers p40 and p63 and against the cytoplasmic markers CK 5/6 and CK 14. A cytoplasmic reactivity to p16 is TNM- relevant in ENT tumors and helps diagnose cancer precursors e.g. B. on the cervix uteri (severe cancer precursors are usually positive). Possibly. p53 can also be aberrantly expressed. If necessary, an HPV infection can be detected by means of in situ hybridization .

Squamous cell carcinoma is associated with mutated mitochondrial DNA , which can serve as a predictive marker and is a potential therapeutic target.

In the differential diagnosis of poorly differentiated squamous cell carcinoma, e.g. B. adenocarcinomas , melanomas , mesotheliomas , sarcomas and the like. a. into consideration.

therapy

Standard therapy is complete surgical removal of the tumor. In the case of carcinomas with a very high risk of the formation of daughter tumors ( metastases ), preventive surgery on the adjacent lymph nodes may be necessary. If an operation is not possible for medical reasons or if there are very extensive early forms of cancer, there are a number of therapeutic alternatives. These primarily include superficial destructive measures such as curettage , electrodesiccation, cryotherapy (freezing), photodynamic therapy , local chemotherapy (5-fluorouracil cream), local immunotherapy (imiquimod cream) and radiation therapy .

Tumors in the advanced stage (lymph node involvement and / or metastases in other organs) can be treated in addition to surgery with systemic chemotherapy, i.e. throughout the body, as well as immunotherapy (interferon-alpha).

Squamous cell carcinomas of the skin generally respond well to chemotherapy at first, but very often have a tendency to relapse (relapse), so that a cure is usually not possible.

Recently an off-label therapeutic application of the 9-valent HPV vaccine has been discussed. The vaccine is injected directly into various skin tumors in the patient. This can be an option, especially for older people with an aggressive form of squamous cell carcinoma. In July 2018 it was reported that an elderly woman over 90 years of age had completely healed. She had several aggressive inoperable squamous cell carcinomas.

Course of disease

The earlier squamous cell carcinoma of the skin is detected and treated, the better its prognosis. Tumors less than 2 cm in size rarely metastasize and have the best chance of recovery. Most squamous cell carcinomas are recognized at this stage and can therefore be treated well. If daughter tumors have formed, the prognosis is significantly less favorable.

Follow-up examinations take place every three to six months, depending on the risk of metastases or relapse. Although most relapses and metastases occur within the first two years, follow-up care should generally be carried out over five years. Patients should also avoid the risk factor UV light and regularly check their skin themselves. A dermatologist should always be consulted if the skin changes are unclear.

The number of skin cancer cases in Germany has doubled in the last ten years (before 2013) to around 235,000 new cases each year:

  • In the first place is the basalioma (basal cell cancer) with approx. 137,000 cases annually.
  • In second place is squamous cell carcinoma (spinalioma) with around 70,000 new cases per year.
  • In third place is malignant melanoma (black skin cancer) with around 28,000 cases annually in Germany.

International experts hold UV-related skin damage that was acquired in childhood and adolescence responsible for this trend.

Occupational illness and reporting requirement

Since January 1, 2015, "Squamous cell carcinomas or multiple actinic keratoses of the skin due to natural UV radiation" have been included as BK No. 5103 in Appendix 1 of the Occupational Diseases Ordinance (BKV) and must therefore be reported to the responsible trade association .

literature

  • Ursus-Nikolaus Riede, Hans-Eckart Schaefer: General and special pathology. Thieme, Stuttgart 1999, ISBN 3-13-683304-X .
  • Dr. med. Dirk Hasselmann: Light skin cancer: Recognize. To treat. Protect oneself. 1st edition. ISBN 978-3-7450-4315-0

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO Version 2019, Volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 702
  2. ^ S. Lal, Jayanta Bain, AKSingh, PK Shukla: Saree Cancer: The Malignant Changes in Chronic Irritation . In: Journal of Clinical and Diagnostic Research . tape 6 , no. 4 ( PDF ). PDF ( Memento of the original from November 11, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.jcdr.org.in
  3. ↑ T. Yamamoto, Y. Tsurumaki, M. Takei, M. Hosaka, Y. Oomori: In vitro method for prediction of the phototoxic potentials of fluoroquinolones . In: Toxicology in vitro: an international journal published in association with BIBRA . tape 15 , no. 6 , December 2001, ISSN  0887-2333 , p. 721-727 , PMID 11698174 .
  4. ↑ Helen J. Reavy, Nicola J. Traynor, Neil K. Gibbs: Photogenotoxicity of Skin Phototumorigenic Fluoroquinolone Antibiotics Detected Using the Comet Assay . In: Photochemistry and Photobiology . tape 66 , no. 3 , September 1, 1997, ISSN  1751-1097 , pp. 368–373 , doi : 10.1111 / j.1751-1097.1997.tb03160.x ( wiley.com [accessed April 15, 2018]).
  5. ↑ G. Klecak, F. Urbach, H. Urwyler: Fluoroquinolone antibacterials enhance UVA-induced skin tumors . In: Journal of Photochemistry and Photobiology. B, Biology . tape 37 , no. 3 , February 1997, ISSN  1011-1344 , pp. 174-181 , PMID 9085564 .
  6. ↑ Quinolone antibacterials: A new class of photochemical carcinogens . In: Journal of Photochemistry and Photobiology B: Biology . tape 37 , no. 3 , February 1, 1997, ISSN  1011-1344 , pp. 182-187 , doi : 10.1016 / S1011-1344 (96) 07425-8 ( sciencedirect.com [accessed April 15, 2018]).
  7. ↑ AD Katsambas, TM Lotti, C. Dessinioti, AM D'Erme (Ed.): European Handbook of Dermatological Treatments. 3. Edition. Springer, Berlin / Heidelberg 2015, p. 242 .
  8. ^ Matthew Peacock, Reto Brem, Peter Macpherson, Peter Karran: DNA repair inhibition by UVA photoactivated fluoroquinolones and vemurafenib . In: Nucleic Acids Research . tape 42 , no. 22 , December 16, 2014, ISSN  0305-1048 , p. 13714-13722 , doi : 10.1093 / nar / gku1213 , PMID 25414333 , PMC 4267641 (free full text).
  9. ↑ G. Ouédraogo, P. Morlière, R. Santus, null Miranda, JV Castell: Damage to mitochondria of cultured human skin fibroblasts photosensitized by fluoroquinolones . In: Journal of Photochemistry and Photobiology. B, Biology . tape 58 , no. 1 , October 2000, ISSN  1011-1344 , pp. 20-25 , PMID 11195848 .
  10. ↑ SL Prior, AP Griffiths, JM Baxter, PW Baxter, SC Hodder: Mitochondrial DNA mutations in oral squamous cell carcinoma . In: Carcinogenesis . tape 27 , no. 5 , May 2006, ISSN  0143-3334 , p. 945-950 , doi : 10.1093 / carcin / bgi326 , PMID 16407369 .
  11. ↑ The role of mitochondrial DNA alterations in esophageal squamous cell carcinomas . In: The Journal of Thoracic and Cardiovascular Surgery . tape 139 , no. 1 , January 1, 2010, ISSN  0022-5223 , p. 189–197.e4 , doi : 10.1016 / j.jtcvs.2009.04.007 ( sciencedirect.com [accessed April 15, 2018]).
  12. ↑ Katsuhiro Uzawa, Takao Baba, Fumihiko Uchida, Masanobu Yamatoji, Atsushi Kasamatsu: Circulating tumor-derived mutant mitochondrial DNA: a predictive biomarker of clinical prognosis in human squamous cell carcinoma . In: Oncotarget . tape 3 , no. 7 , July 25, 2012, ISSN  1949-2553 , p. 670-677 , PMID 22832574 , PMC 3443250 (free full text).
  13. ↑ Emine C. Koc, Ebru Haciosmanoglu, Pier Paolo Claudio, Allison Wolf, Luigi Califano: Impaired mitochondrial protein synthesis in head and neck squamous cell carcinoma . In: Mitochondrion . tape September 24 , 2015, ISSN  1872-8278 , p. 113-121 , doi : 10.1016 / j.mito.2015.07.123 , PMID 26238294 .
  14. ↑ Daisuke Takeda, Takumi Hasegawa, Takeshi Ueha, Akiko Sakakibara, Teruya Kawamoto: Decreased mitochondrial copy numbers in oral squamous cell carcinoma . In: Head & Neck . tape 38 , no. 8 , August 1, 2016, ISSN  1097-0347 , p. 1170–1175 , doi : 10.1002 / hed.24194 ( wiley.com [PDF; accessed April 15, 2018]).
  15. ^ Andrew D. Bowser: HPV vaccine: New therapeutic option for SCC? In: mdedge.com. July 3, 2018, accessed August 10, 2018 .
  16. ↑ Archive messages single view. In: www.krebshilfe.de. Retrieved February 3, 2016 .
  17. ↑ https://beruflicher-hautschutz.de/w/BK-Nr._5103

Web links

Commons : Squamous Cell Carcinoma  - Collection of Pictures, Videos, and Audio Files