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Journal of Skin Cancer
Volume 2013, Article ID 752864, 10 pages
Review Article

Simulators of Squamous Cell Carcinoma of the Skin: Diagnostic Challenges on Small Biopsies and Clinicopathological Correlation

1Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Lower Kent Ridge Road, Singapore 119074
2University Medicine Cluster, National University Health System, Singapore 119074
3University Surgical Cluster, National University Health System, Singapore 119074
4Departments of Otorhinolaryngology and Hand and Reconstructive Microsurgery, National University Health System, Singapore 119074

Received 8 May 2013; Revised 30 May 2013; Accepted 30 May 2013

Academic Editor: Giuseppe Argenziano

Copyright © 2013 Kong-Bing Tan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Squamous cell carcinoma (SCC) is a common and important primary cutaneous malignancy. On skin biopsies, SCC is characterized by significant squamous cell atypia, abnormal keratinization, and invasive features. Diagnostic challenges may occasionally arise, especially in the setting of small punch biopsies or superficial shave biopsies, where only part of the lesion may be assessable by the pathologist. Benign mimics of SCC include pseudoepitheliomatous hyperplasia, eccrine squamous syringometaplasia, inverted follicular keratosis, and keratoacanthoma, while malignant mimics of SCC include basal cell carcinoma, melanoma, and metastatic carcinoma. The careful application of time-honored diagnostic criteria, close clinicopathological correlation and a selective request for a further, deeper, or wider biopsy remain the most useful strategies to clinch the correct diagnosis. This review aims to present the key differential diagnoses of SCC, to discuss common diagnostic pitfalls, and to recommend ways to deal with diagnostically challenging cases.