title: The clinical and dermoscopic features of invasive cutaneous squamous cell carcinoma depend on the histopathological grade of differentiation.
abstract: BACKGROUND
  Little is known about the variability of the dermoscopic criteria of squamous cell carcinoma (SCC) according to the histopathological differentiation grade.
  
  
  OBJECTIVE
  To evaluate whether specific dermoscopic criteria can predict the diagnosis of poorly differentiated SCC compared with well- and moderately differentiated SCC.
  
  
  METHODS
  Clinical and dermoscopic images of SCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves.
  
  
  RESULTS
  Of 143 SCCs included, 48 (33·5%) were well differentiated, 45 (31·5%) were moderately differentiated and 50 (35·0%) were poorly differentiated. Flat tumours had a fourfold increased probability of being poorly differentiated. Dermoscopically, the presence of a predominantly red colour posed a 13-fold possibility of poor differentiation, whereas a predominantly white and white-yellow colour decreased the odds of poorly differentiated SCC by 97% each. The presence of vessels in more than 50% of the tumour's surface, a diffuse distribution of vessels and bleeding were significantly associated with poor differentiation, while scale/keratin was a potent predictor of well- or moderately differentiated tumours.
  
  
  CONCLUSIONS
  Dermoscopy may be regarded as a reliable preoperative tool to distinguish poorly from well- and moderately differentiated SCC. Given that poor differentiation of SCC represents an independent risk factor for recurrence, metastasis and disease-specific death, identifying poorly differentiated tumours in vivo may enhance their appropriate management.
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lallas
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Pyne
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: Dermatology Service Hospital Salvador, Santiago, Chile.
authors.forename: S
authors.initials: S
authors.lastname: Andreani
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Hospital Santa Casa, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Cavaller
authors.affiliation: Skin Spectrum Medical Services, Como, Western Australia, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Giacomel
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Longo
authors.affiliation: Albert Einstein Israelite Hospital, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Malvestiti
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Moscarella
authors.affiliation: Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piana
authors.affiliation: Department of Dermatology, University of Rome Tor Vergata, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Specchio
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: I
authors.initials: I
authors.lastname: Zalaudek
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002471:Cell Transformation, Neoplastic; D046169:Dermoscopy / Q000379:methods; D005121:Extremities; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D012372:ROC Curve; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D060726:Torso