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Journal of the American Academy of Dermatology
Volume 74, n° 2
pages 356-362 (février 2016)
Doi : 10.1016/j.jaad.2015.09.060
accepted : 23 September 2015

Histopathologic assessment of depth of follicular invasion of squamous cell carcinoma (SCC) in situ (SCCis): Implications for treatment approach

Sean R. Christensen, MD, PhD a, , Jennifer M. McNiff, MD a, Alicia J. Cool, MD a, Sumaira Z. Aasi, MD b, Allison M. Hanlon, MD, PhD a, David J. Leffell, MD a
a Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 
b Department of Dermatology, Stanford University School of Medicine, Palo Alto, California 

Reprint requests: Sean R. Christensen, MD, PhD, Department of Dermatology, Yale University School of Medicine, 40 Temple St, Suite 5A, New Haven, CT 06510.

Squamous cell carcinoma in situ (SCCis) has been reported to involve the hair follicle epithelium. Deep follicular invasion is often cited as a cause of treatment failure.


We sought to define the frequency and the depth of hair follicle invasion by SCCis.


The study included both a retrospective review of intraoperative pathology specimens from 42 SCCis cases treated with Mohs micrographic surgery and a prospective evaluation of serially sectioned SCCis tissue from 12 additional patients. Pathology specimens were analyzed for follicular invasion of SCCis.


SCCis invasion of the superficial hair follicle infundibulum was observed in 61.3% to 87.5% of cases in the 2 cohorts, whereas invasion of the isthmus and lower follicle was observed in only 8.3% to 12.5% of cases. In most tumors the depth of follicular invasion was comparable with the thickness of the surrounding epidermis. The maximum observed depth of follicular invasion was 0.82 mm.


The study was performed on a limited number of cases referred for surgery at a single institution.


Although SCCis invasion of the upper hair follicle infundibulum is common, deep invasion below the level of the surrounding epidermis is rare. This may have implications for optimal therapy of this condition.

The full text of this article is available in PDF format.

Key words : adnexal structure, Bowen disease, cutaneous, depth, hair follicle, histology, Mohs micrographic surgery, pathology, sebaceous gland, squamous cell carcinoma in situ

Abbreviations used : ICC, SCC, SCCis

 Funding sources: None.
 Conflicts of interest: None declared.
 Interim results of this study were presented as abstracts at the American College of Mohs Surgery Annual Meetings on April 29, 2011 in Las Vegas, NV and on May 2, 2013 in Washington, DC. The complete study has never been presented before.

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