Perforating elastic fibers ('elastic fiber trapping') in the differentiation of keratoacanthoma, conventional squamous cell carcinoma and pseudocarcinomatous epithelial hyperplasia Journal Article

  

Authors:	Shah, K.; Kazlouskaya, V.; Lal, K.; Molina, D.; Elston, D. M.
Article Title:	Perforating elastic fibers ('elastic fiber trapping') in the differentiation of keratoacanthoma, conventional squamous cell carcinoma and pseudocarcinomatous epithelial hyperplasia
Abstract:	Keratoacanthoma (KA), an epithelial neoplasm occurring in sun-exposed skin of the elderly, is considered a well-differentiated form of conventional squamous cell carcinoma (SCC) that often follows a course of spontaneous regression. Distinguishing KA from conventional SCC or pseudocarcinomatous epithelial hyperplasia ensures proper diagnosis, treatment and management. For some time, perforating elastic fibers have been utilized in differentiating KA from SCC. This phenomenon may also occur in association with scars and hypertrophic lupus erythematosus (LE). To assess the diagnostic utility of perforating elastic fibers, we compared their incidence in KA, SCC, scars with overlying pseudocarcinomatous hyperplasia, hypertrophic LE, hypertrophic lichen planus (LP) and lichen simplex chronicus (LSC). A retrospective case search identified 359 lesions and the presence of perforating elastic fibers was evaluated using routinely stained sections. This phenomenon was documented in all studied groups except hypertrophic LP. The incidence was found to be 71% in KA, 37% in SCC, and was lowest in inflammatory conditions with associated pseudocarcinomatous hyperplasia (hypertrophic LP 0%, hypertrophic LE 5.9% and LSC 28.2%). The observed frequency in pseudocarcinomatous hyperplasia overlying scars (57.8%) vs. KA (71%) was not statistically different. Although elastic fiber trapping has potential value as a diagnostic criterion for KA, dermatopathologists should consider its limitations. Its diagnostic utility was greatest in distinguishing KA from hypertrophic LE and hypertrophic LP. Conversely, elastic trapping is not helpful differentiating pseudocarcinomatous hyperplasia from recurrent/persistent KA following surgery. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Keywords:	squamous cell carcinomas; scar; non-melanoma skin; cutaneous neoplasm; cancer
Journal Title:	Journal of Cutaneous Pathology
Volume:	41
Issue:	2
ISSN:	0303-6987
Publisher:	John Wiley & Sons
Date Published:	2014-02-01
Start Page:	108
End Page:	112
Language:	English
DOI:	10.1111/cup.12247
PROVIDER:	scopus
PUBMED:	24138600
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84893689608&partnerID=40&md5=6258a80b3e93cb827ed149d0f130a96f
Notes:	Export Date: 3 March 2014 -- CODEN: JCUPB -- Source: Scopus

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