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Histology of skin cancer (non-melanoma)

The microscopic diagnosis of the most common cancer types originating in the skin, such as squamous cell and basal cell carcinomas is often simple and reproducible. Squamous cell carcinoma precursors exist, such as atypical squamous cell hyperplasia and carcinoma in situ.

 

Skin specimen with a basal cell carcinoma. Click to enlarge. Photomicrograph demonstrating a basal cell carcinoma. Click to enlarge. Photomicrograph demonstrating a squamous cell carcinoma. Click to enlarge.

It is important that operation specimens are handled in such a way that the resection margins can be evaluated reliably.  In addition to evaluate tumor type and resection margins, the pathologist should also determine whether the basal cell carcinomas belong to an aggressively growing subtype.

Cytology is a simple and rapid method to diagnose basal cell carcinomas in scraping material, especially useful when photodynamic therapy is considered.  

Photomicrograph from smear of skin scrape in a basal cell carcinoma. Click to enlarge. Photomicrograph from smear of skin scrape in a basal cell carcinoma. Click to enlarge.

Kaposis sarcoma originates from blood vessels and can in an early phase look like hemangioma (benign tumor of the vessels). In some instances multiple biopsies are therefore needed before a final diagnosis can be established. Spindle cells and intercellular space with red blood cells is seen microscopically in the established phase.

Merkel cell carcinoma (neuroendocrine carcinoma of the skin) orginate from neuroendocrince cells in the skin. Microscopically, this is a small cell tumor where immunohistochemistry is often necessary to establish the diagnosis. Fine needle aspiration can also be used to diagnose this tumor. 

Photomicrograph showing a giemsa stained smear from an aspirate of a Merkel cell carcinoma. Click to enlarge. Photomicrograph demonstrating a Merkel cell carcinoma in an H&E stained histological section. Click to enlarge.

Skin adnexal tumors originate from hair follicles, sweat glands and sebaceous glands. They include many subtypes, most of them benign, but there are also malignant ones. Microscopically, it can sometimes be difficult to separate between the benign and malignant ones.

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