Management of Endophytic Squamoproliferative Lesion with Involution
The recommended management for an endophytic squamoproliferative lesion with involution is wide local excision with appropriate margin control, followed by multidisciplinary review to guide further treatment decisions. 1
Diagnostic Evaluation
- Complete clinical examination of the lesion, noting any features suspicious for malignancy such as non-healing wounds, rapid growth, altered sensation, or hyperkeratosis 1
- Biopsy of the suspicious area for histopathological confirmation is essential before definitive treatment 1
- Provide the pathologist with key clinical information including patient demographics, anatomic location, lesion size, and relevant risk factors 1
- Histopathological assessment should evaluate:
- Degree of cellular differentiation
- Presence of aggressive histologic subtypes
- Depth of invasion
- Presence of perineural or lymphovascular invasion 1
Surgical Management
- Wide local excision is the treatment of choice for squamoproliferative lesions 1
- For lesions ≥5 cm in diameter or those in anatomically complex locations, pre-operative imaging with MRI or CT is recommended to assess tumor extent 1
- The surgical approach should be discussed with the patient, balancing the need for complete removal with functional and cosmetic outcomes 1
- For lesions with extensive involvement or in difficult anatomical sites where wide excision is not feasible, more radical approaches may be necessary 1
Post-Excision Management
- All cases should be discussed in a multidisciplinary meeting with dermatologists, plastic surgeons, histopathologists, and oncologists 1
- Regional lymph node assessment should be performed if clinically suspicious 1
- If lymphadenopathy is present, ultrasound-guided fine-needle aspiration or surgical biopsy should be performed 1
- Positive lymph node biopsy should prompt consideration of regional lymph node dissection 1
Follow-up Protocol
- Regular clinical surveillance is essential following treatment 1
- For patients with completely excised lesions without high-risk features, follow-up examinations every 3-6 months for the first year, then annually 1
- Any persistent ulceration, new growth, or suspicious changes should prompt immediate re-evaluation 1
- Photography of the site at baseline for later comparison may be helpful 1
Special Considerations
- Endophytic growth patterns can sometimes create diagnostic confusion with other entities like inverted papilloma, keratoacanthoma, or squamous cell carcinoma 2, 3, 4
- Immunohistochemical analysis may be helpful in distinguishing between benign and malignant endophytic lesions 3, 5
- For lesions with involution, careful histopathological assessment is crucial to distinguish between benign involuting lesions and more aggressive entities 6
Pitfalls to Avoid
- Delay in biopsy of suspicious lesions can lead to missed diagnosis of malignancy 1
- Inadequate surgical margins increase risk of recurrence 1
- Failure to assess regional lymph nodes in cases with high-risk features 1
- Overlooking the possibility of malignant transformation in longstanding lesions 1
By following this management approach, clinicians can ensure appropriate treatment of endophytic squamoproliferative lesions while minimizing the risk of recurrence and optimizing functional and cosmetic outcomes.