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Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut

Actinic keratosis, Bowen’s disease, keratoacanthoma and squamous cell carcinoma of the skin

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Zusammenfassung

Die aktinische Keratose (AK) ist eine intraepidermale plattenepitheliale Neoplasie in lichtgeschädigter Haut und die mit Abstand häufigste neoplastische Hauterkrankung. Die Graduierung in 3 Schweregrade (Grad I–III) wird vorgeschlagen und zunehmend akzeptiert, nicht zuletzt aufgrund therapeutischer Konsequenzen. Der Übergang der AK in ein invasives Plattenepithelkarzinom wird bei bis zu 5–10 % der Patienten und bei Immunsuppression bei bis zu 30 % der Patienten beschrieben.

Der Morbus Bowen (MB) ist eine Variante des plattenepithelialen Carcinoma in situ der Haut und der Haut-Schleimhaut-Übergänge. Wichtig ist die Abgrenzung von der „bowenoiden Papulose“ als HPV-assoziierte Erkrankung des äußeren Genitale bzw. der genitalen Schleimhäute, der aktinischen Keratose vom bowenoid proliferierenden Typ (AK Grad III), intraepithelialen poroiden Tumoren und bei klonalem Wachstum von der klonalen seborrhoischen Keratose und dem Morbus Paget.

Das Keratoakanthom (KA) wird mittlerweile mehrheitlich als hochdifferenzierte Variante des Plattenepithelkarzinoms der Haut mit klinischen und histologischen Charakteristika gewertet. Klinische Charakteristika sind schnelles Wachstum und spontane Remission. Histologische Besonderheiten sind v. a. Wachstumsmuster und Rückbildung über fortschreitende Stadien der Regression. Die definitive Diagnose sollte ausschließlich am kompletten Untersuchungsmaterial erfolgen.

Das Plattenepithelkarzinom (PEC bzw. „squamous cell carcinoma“ [SCC]) der Haut ist nach dem Basaliom die zweithäufigste maligne Neoplasie der Haut. Im Hinblick auf Rezidivneigung und Metastasierungsrisiko ist eine Subtypisierung kutaner SCC äußerst wichtig. Die Tumorklassifikation nach der Union Internationale Contra le Cancer (UICC) orientiert sich ausschließlich an der anatomisch basierten Ausbreitung, die Klassifikation nach dem American Joint Committee on Cancer (AJCC) berücksichtigt zudem bei der Stadiendifferenzierung im Stadium I und II sogenannte Hochrisikofaktoren.

Abstract

Actinic (solar) keratosis is an intraepidermal squamous neoplasm of sun-damaged skin and by far the most frequent neoplastic skin lesion. A subdivison into three grades has been proposed with increasing acceptance not least because of the therapeutic consequences. The transition to invasive squamous cell carcinoma is reported in 5–10 % and with immunosuppression in 30 % of patients.

Bowen’s disease is a variant of squamous cell carcinoma in situ of the skin and the mucocutaneous junction. The differentiation from bowenoid papulosis as a lesion associated with human papillomavirus (HPV), actinic (solar) keratosis grade III, intraepidermal poroid lesions and in cases of clonal type from clonal seborrhoic keratosis and Paget’s disease is very important.

Keratoacanthoma is currently uniformly interpreted as a variant of highly differentiated squamous cell carcinoma of the skin with clinical and histomorphological characteristics. Clinically keratoacanthoma erupts rapidly and is capable of resolving spontaneously. Histologically, there is a characteristic growth pattern and various stages of regression. The final histomorphological diagnosis needs the entire specimen.

Squamous cell carcinoma of the skin is the second most common type of skin cancer following basal cell carcinoma. With respect to reccurrencies and risk of metastases the subtyping of cutaneous squamous cell carcinoma is very important. The classification system of the Union Internationale Contra le Cancer (UICC) is based solely on the anatomical spread and the classification system of the American Joint Committee on Cancer (AJCC) also considers so-called high-risk features in the staging between stages I and II.

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Danksagung

Ein besonderer Dank gilt den ärztlichen Kollegen des Heinz-Werner-Seifert-Instituts für Dermatopathologie, Bonn, für die stete diagnostische Unterstützung und die anregenden Diskussionen.

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Interessenkonflikt. E. Bierhoff und M. Majores geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Majores, M., Bierhoff, E. Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut. Pathologe 36, 16–29 (2015). https://doi.org/10.1007/s00292-014-2063-3

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