Why does follicular involvement matter?

What is the significance of “follicular involvement” in a biopsy pathology report?

One of the questions we get from some of the providers that send us biopsies is “Why, when we make a diagnosis of actinic keratosis, squamous cell carcinoma or Bowen’s disease “with follicular involvement” — why we say that.”
The main reason is sometimes you may have biopsied someone and it shows and actinic keratosis or an AK and it doesn’t respond to treatment. If we notice that it does extend along the follicles, it’s to help the provider be aware that normal treatments may not be effective for that because it is extending along the follicle— especially in areas of the body that have terminal hair that grow down quite a bit deeper. Sometimes those atypical cells can extend deeper and be a little more challenging to treat. The same thing goes with Bowen’s disease or squamous cell carcinoma in situ. Some of the local or superficial treatments we do may be insufficient to cure those on areas with terminal hair where they extend a lot deeper.

Dr. Greg Wells, Dermatology Trained Dermatopathologist

See the study “Evaluation of the Prognostic Significance of Follicular Extension in Actinic Keratoses”


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