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However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (\u22642% metastatic rate), intermediate (3\u201310%), high (greater than 10%), and indeterminate behavior. Low\u2010risk SCCs include SCC arising in actinic keratosis, HPV\u2010associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate\u2010risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma\u2010like carcinoma of the skin. High\u2010risk subtypes include\n                    <jats:italic>de novo<\/jats:italic>\n                    SCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear\u2010cell SCC. Subclassification of SCC into these risk\u2010based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients.\n                  <\/jats:p>","DOI":"10.1111\/j.0303-6987.2006.00516.x","type":"journal-article","created":{"date-parts":[[2006,2,7]],"date-time":"2006-02-07T11:31:31Z","timestamp":1139311891000},"page":"261-279","source":"Crossref","is-referenced-by-count":202,"title":["Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification"],"prefix":"10.1111","volume":"33","author":[{"given":"David S.","family":"Cassarino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian P.","family":"DeRienzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald 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