When a pathology report shows SCC not connected to the epidermis, how often is this truly metastatic versus a sampling artifact, and do you routinely pursue full metastatic workup or referral in these cases?

Clinical correlation is always required, but, overall in my experience, partial samplings of SCC not connected to background epithelium in the tissue sections are more likely undermining extension of a primary tumor than metastasis, and the submitted clinical impression correlates with this. Perineu...

Primary SCCs typically do have a connection to the epidermis. This is customarily found upon microscopic evaluation of an entire specimen of the SCC. However, partial biopsies, such as a punch biopsy, may show an area where the SCC is undermining the epidermis without a connection. In such a situati...