Dermoscopy of cutaneous squamous cell carcinoma by anatomical location and risk stratification: a retrospective cross-sectional study

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers. It develops from keratinocytes (the main cells in the outer layer of the skin). Some cSCCs behave in a more aggressive way, meaning they are more likely to grow deeply, return after treatment, or spread to lymph nodes or other organs. For this reason, recognising features linked to higher-risk tumours is important for planning care.
This study was carried out at the Skin Cancer Center of Arcispedale Santa Maria Nuova in Reggio Emilia, Italy.
We wanted to understand whether dermoscopy (a clinical tool where a dermatologist uses a special light and lens to see magnified structures and blood vessels in the skin) can help clinicians predict which cSCCs may be “higher risk” based on NCCN risk classification, and whether these patterns change depending on the body site. In this system, “very-high risk” includes tumours that are large and/or “poorly differentiated” (meaning the cancer cells look more abnormal under the microscope).
We reviewed consecutive cases from January 2011 to December 2021 and included 768 invasive cSCCs with clinical photos, dermoscopy images, and a confirmed diagnosis on histology. Two dermatologists assessed the dermoscopy images without knowing the pathology results, and we used statistical models to identify signs linked to very-high risk tumours.
We found that dermoscopy patterns varied by anatomical site, and that higher-risk groups more often showed ulceration and mixed types of blood vessels. In head and neck tumours, very-high risk (poorly differentiated) cancers were more likely when we saw ulceration and yellow crust (often dried fluid/exudate), and in older patients. Some findings, such as dotted-glomerular vessels, white circles, and vessels mainly at the edge of the lesion, were linked with lower risk.
We conclude that dermoscopy may help clinicians prioritise lesions for faster biopsy and treatment, potentially improving early risk assessment before pathology is available. Dermoscopy is intended to complement histopathology, and our results provide a basis for future prospective, multicentre studies to confirm these patterns and refine their clinical use.

皮肤鳞状细胞癌（Cutaneous squamous cell carcinoma, cSCC）是最常见的皮肤恶性肿瘤之一，起源于角质形成细胞（keratinocytes）——皮肤外层的主要细胞类型。部分cSCC具有更高的侵袭性，表现为更易深层浸润、治疗后复发，或发生淋巴结及远处器官转移。因此，识别与高风险肿瘤相关的特征，对制定诊疗方案具有重要意义。
本研究于意大利雷焦艾米利亚的Arcispedale Santa Maria Nuova皮肤癌中心开展。
我们旨在明确皮肤镜检查（dermoscopy）——一种由皮肤科医师借助专用光源与镜头，放大观察皮肤结构及血管的临床工具——能否帮助临床医师基于美国国家综合癌症网络（National Comprehensive Cancer Network, NCCN）风险分级系统，预测哪些cSCC属于“高风险”，同时明确这些皮肤镜表现是否随解剖部位不同而发生变化。该分级系统中，“极高风险”包含体积较大和/或“低分化”的肿瘤（即显微镜下癌细胞异型性更为显著）。
我们回顾了2011年1月至2021年12月的连续病例，最终纳入768例经组织病理学确诊的侵袭性cSCC，所有病例均配有临床照片、皮肤镜图像及确诊组织学结果。两名皮肤科医师在不知晓病理结果的前提下对皮肤镜图像进行评估，随后我们采用统计模型筛选与极高风险肿瘤相关的征象。
研究结果显示，皮肤镜表现随解剖部位不同存在差异，且高风险肿瘤更常出现溃疡及混合型血管。在头颈部肿瘤中，若观察到溃疡、黄色痂皮（多为干燥的渗出液/渗出物）以及患者年龄较大，则更可能为低分化的极高风险癌。部分征象如点状-肾小球状血管、白色环以及主要分布于病变边缘的血管，则与较低风险相关。
综上，皮肤镜检查可帮助临床医师优先对病变进行快速活检与治疗，有望在获得病理结果前优化早期风险评估流程。皮肤镜检查旨在作为组织病理学的补充手段，本研究结果为未来开展前瞻性多中心研究以验证上述表现并优化其临床应用提供了依据。