Skin nonmelanocytic tumor

Carcinoma (nonadnexal)

Spindle cell squamous cell carcinoma

Topic Completed: 1 November 2014

Minor changes: 15 October 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Spindle cell squamous cell carcinoma

Ghassan A. Tranesh, M.D.
Hong Qu, M.D.
Page views in 2020: 6,413
Page views in 2021 to date: 5,449
Cite this page: Tranesh GA, Qu H. Spindle cell squamous cell carcinoma. website. Accessed October 25th, 2021.
Definition / general
  • Cutaneous spindle cell squamous carcinoma is an uncommon variant of squamous cell carcinoma, in which (a) keratinocytes infiltrate dermis as single cells with elongated nuclei, not as cohesive nests or islands, and (b) there are no / minimal signs of keratinization of conventional squamous cell carcinoma (Am J Dermatopathol 2008;30:228)
  • Also called metaplastic carcinoma
  • Carcinosarcoma: sharp segregation exists between epithelial and sarcoma-like areas.
  • Sarcoma-like tumor of skin: cannot rule out a mesenchymal tumor
  • Older patients with a significant history of sun exposure
  • No sex predilection
Clinical features
  • Due to sun exposure, ionizing radiation or trauma
  • Tumors not associated with radiation are often indolent and only rarely metastasize
  • Tumors associated with radiation or trauma are often more aggressive
Prognostic factors
  • Increased tumor size and depth are significant prognostic factors
Case reports
  • No definite treatment protocol exists, but aggressive, wide local excision recommended
  • Adjuvant radiation or chemotherapy have been used anecdotally
Radiology images

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Nasal cavity mass

Clinical images

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Nasal cavity mass

Microscopic (histologic) description
  • Cytologically malignant spindled cells arranged in sheets or occasionally in storiform pattern
  • Tumor is contiguous with basal layer of epidermis
  • Usually at least focal squamous cell carcinoma
  • Mitoses readily identified
  • Adjacent actinic keratosis is often present
Microscopic (histologic) images

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Poorly differentiated tumor and p63

Nose: H&E, AE1/AE3, vimentin

Positive stains
  • Cytokeratin, includining pan-keratin and cytokeratin 5/6
  • Cytokeratin positivity may be spotty or weak, however, and use of two cytokeratin markers is recommended
  • p63 (J Cutan Pathol 2006;33:413)
Negative stains
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