title: Squamous Cell Carcinoma In Situ Upstaged to Invasive Squamous Cell Carcinoma: A 5-Year, Single Institution Retrospective Review.
abstract: BACKGROUND
  Shave biopsy may not be able to accurately distinguish squamous cell carcinoma in situ (SCCIS) from invasive squamous cell carcinoma (SCC). Information on the incidence of biopsy-proven SCCIS upstaged to SCC after a more complete histologic examination is limited.
  
  
  OBJECTIVE
  To determine the incidence and clinical risk factors associated with upstaging the biopsy diagnosis of SCCIS into invasive SCC based on findings during Mohs micrographic surgery (MMS).
  
  
  METHODS
  All MMS cases of SCCIS performed between March 2007 and February 2012 were identified, MMS operative notes were examined, and invasive dermal components were confirmed by the MMS slide review. Upstaged SCCIS was defined as biopsy-diagnosed SCCIS subsequently found to be an invasive SCC during MMS.
  
  
  RESULTS
  From 566 cases with the preoperative diagnosis of SCCIS, 92 (16.3%) cases were SCCIS upstaged to SCC. Location of ears, nose, lips, and eyelids, preoperative diameter >10 mm, and biopsy report mentioning a transected base were significant predictors of upstaged SCCIS.
  
  
  CONCLUSIONS
  Considering the possibility that over 16% of SCCIS may be truly invasive SCC, biopsy-proven SCCIS should be treated adequately with margin-assessed treatment modalities such as surgical excision or Mohs surgery when indicated.
authors.affiliation: *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; †Department of Dermatology, University of California, San Diego, Medical Center, La Jolla, California; ‡Compass Dermatopathology, La Jolla, California; §Department of Dermatology and Mohs Surgery, Southern California Permanente Medical Group, Fontana, California; ‖Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ¶Department of Dermatology, University of Pittsburgh Medical Center Health System, Pittsburg, Pennsylvania.
authors.forename: Sasima
authors.initials: S
authors.lastname: Eimpunth
authors.forename: Alina
authors.initials: A
authors.lastname: Goldenberg
authors.forename: Michael Shane
authors.initials: MS
authors.lastname: Hamman
authors.forename: Gagik
authors.initials: G
authors.lastname: Oganesyan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lee
authors.forename: Saowalak
authors.initials: S
authors.lastname: Hunnangkul
authors.forename: Silvia Soohyun
authors.initials: SS
authors.lastname: Song
authors.forename: Tanya
authors.initials: T
authors.lastname: Greywal
authors.forename: Shang I Brian
authors.initials: SIB
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery