Differential Diagnosis

The diagnosis of SCC must be confirmed by a biopsy, which must be taken from the clinically most suspicious area, avoiding the central necrotic area. In well-oriented, adequate biopsy samples, the diagnosis does usually not present a diagnostic problem, as evidence of invasive growth and of squamous differentiation is easily found.

However, well-differentiated SCCs must be distinguished from verrucous carcinomas and papillary SCCs, as well as from benign conditions, such as pseudoepithe-liomatous hyperplasia. Verrucous carcinomas lack atyp-ia, which are always present in SCCs. Papillary SCCs are characterised by papillae formation. which is not the prevailing feature in conventional SCCs.

Pseudoepitheliomatous hyperplasia is a benign condition associated with granular cell tumours, mycotic infection or tuberculosis. It consists of deep irregular tongues and rete pegs, but there are no abnormal mitoses or atypia, as in SCCs. Identifying the associated condition (granular cell tumour or infection) may be helpful in establishing the diagnosis of pseudoepithelioma-tous hyperplasia.

Poorly differentiated SCCs must be differentiated from malignant melanomas, malignant lymphomas, neuroendocrine carcinomas, adenocarcinomas, and ad-enosquamous carcinomas. The correct diagnosis is best achieved by the use of appropriate immunohistochem-istry and special stains for the demonstration of mucin production.

Malignant melanomas are distinguished from SCCs by the expression of S-100, HMB-45 and melan-A. Neuroendocrine carcinomas express neuroendocrine markers (synaptophysin, chromogranin) and do not show evidence of squamous differentiation, while SCCs do not express neuroendocrine markers. Malignant lymphomas are differentiated from SCCs by the presence of leukocyte common antigen, and markers of B- or T-cell differentiation. Adenocarcinomas and adenosquamous carcinomas can be distinguished from SCCs by the presence of glands and mucin secretion within the tumour cells.

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