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The following is a summary of “Distinguishing Keratoacanthoma from Well-Differentiated Cutaneous Squamous Cell Carcinoma Using Single-Cell Spatial Pathology,” published in the November 2023  issue of Dermatology by Veenstra, et al.

Keratoacanthoma (KA) is a common keratinocyte tumor usually labeled as a type of cutaneous squamous cell cancer (cSCC), even though it acts normally. A lot of the time, it’s hard to tell the difference between KA and well-differentiated cSCC because their clinical and pathological traits are so similar. At this point, there aren’t any good signs that can tell the difference between KAs and cSCC, so KAs are often treated the same way as cSCC, which leads to unnecessary surgery complications and higher healthcare costs. 

Researchers used RNA sequencing to find important differences in the transcriptomes of KA and cSCC. These differences pointed to different groups of keratinocytes in each tumor. Then, imaging mass cytometry was used to discover single-cell tissue features, such as the type of cells present, how often they were found, their shape, their ability to do their job, and how they interacted with KA and well-differentiated cSCC. 

They discovered that cSCC had significantly higher numbers of Ki67+ keratinocytes in the tumor keratinocytes, and these cells were spread out significantly in non-basal keratinocyte communities. More regulatory T-cells and stronger inhibitory power were found in cSCC. Also, cSCC regulatory T-cells, tumor-associated macrophages, and fibroblasts were strongly linked to Ki67⁺ keratinocytes instead of avoiding KA, which suggests a more immune-suppressing environment. The data suggests that multicellular spatial features can serve as a foundation to enhance the histological discrimination of ambiguous KA and cSCC lesions.

Source: sciencedirect.com/science/article/abs/pii/S0022202X23023989