Prevalence of Underdiagnosed Aggressive Non-Melanoma Skin Cancers Treated with Mohs Micrographic Surgery

Izikson, Leonid; Seyler, Marie; Zeitouni, Nathalie C.

doi:10.1111/j.1524-4725.2010.01747.x

Cited by 42 publications

(55 citation statements)

References 6 publications

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“…8 A more recent study showed a 51.1% accuracy rate between biopsy specimen and intraoperative examination of nonmelanoma skin cancers (BCC and squamous cell carcinoma). 10 A major and clinically important finding in our study is an overall 18% discordance rate between tumor subtype identification in the biopsy specimen and the composite BCC subtype. Sampling errors inherent in a small biopsy specimen of a large tumor would in part account for the observed discrepancy.…”

Section: Discussionmentioning

confidence: 96%

“…Similar failure to detect aggressive tumor subtypes has also been reported in Mohs excision specimens where 21.1% of the cases examined intraoperatively revealed an aggressive subtype that was not diagnosed by biopsy specimen. 10 Another notable finding is that 19% of the discordant cases were misidentified as infiltrative BCC in the biopsy specimen as a result of surface ulceration and reactive stromal changes. In these cases, we observed that the biopsy specimen showed nodular BCC with ulceration and stromal reaction that could have altered tumor morphology and mimicked an infiltrative growth pattern.…”

Section: Discussionmentioning

confidence: 98%

“…One study reported that only 10% of the initial biopsy specimens reported BCC with mixed subtypes when these tumors were actually found in 40% of Mohs resections, and a second study reported 51.1% concordance of biopsy specimen with Mohs excision. 8,10 Given the limited numbers of published studies evaluating the adequacy of biopsy specimen for BCC subtyping and the wide differences found in these reports, we undertook a study to systematically compare the tumor subtypes present in the initial biopsy specimen with the composite subtypes present in the biopsy specimen and wide excision. We determined the accuracy rate of biopsy specimen in correctly identifying all the subtypes present in a tumor, and evaluated trends toward misidentification of tumor subtypes.…”

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confidence: 99%

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Accuracy of biopsy sampling for subtyping basal cell carcinoma

Haws

Rojano

Tahan

et al. 2012

Journal of the American Academy of Dermatology

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Accuracy of biopsy sampling for subtyping basal cell carcinoma

Haws

Rojano

Tahan

et al. 2012

Journal of the American Academy of Dermatology

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“…Limited sampling during biopsy and pathology processing 6,7 fails to identify deeper and aggressive tumors in 1 of 6 cases, especially in mixed-histological subtypes 8,9 and in those superficial and nodular BCCs which have deeper components. 7,10 However, complete and accurate assessment of tumor subtype and depth is important for precise diagnosis and management, especially since skin cancer treatment guidelines list non-surgical options for the shallower and less-aggressive subtypes such as superficial and early nodular BCCs (depth ~0.2–0.5 mm) and surgical treatment for the aggressive and deeper subtypes such as micronodular, sclerosing and infiltrative. 3,4,11 Non-invasive optical imaging may help overcome these limitations and enable a more comprehensive assessment of lesions, and facilitate improved diagnosis, subtyping, and depth prediction.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

et al. 2018

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IMPORTANCE The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs.OBJECTIVE To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. DESIGN, SETTING, AND PARTICIPANTSThis pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. MAIN OUTCOMES AND MEASURESImprovements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. RESULTSIn total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R 2 ) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 μm deep. CONCLUSIONS AND RELEVANCECombined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.

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“…Finally, another source of errors is the questionable reliability of the initial biopsy examination. The latter can in fact miss the more aggressive component of a composite BCC in more than 40% of cases [11,17,18]. Composite aggressive and non-aggressive BCCs have been detected in 38.5% of a series of 1,039 cases [11].…”

Section: Discussionmentioning

confidence: 99%

Facial Basal Cell Carcinomas Recurring after Photodynamic Therapy: A Retrospective Analysis of Histological Subtypes

et al. 2012

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Background: Photodynamic therapy (PDT) is an established treatment for basal cell carcinomas (BCCs). Although recurrences are sometime observed, their histological patterns have never been specifically studied or compared with the one of the initial tumor. Objective: To compare the histopathological aggressiveness of BCCs recurring after PDT with that of the primary tumors. Methods: The study population included 12 patients with 16 post PDT recurrent BCCs. Outcome measures were proportion of histologically aggressive subtypes in BCC recurrences vs. primary tumor. Results: 62.5% of recurrent BCCs displayed a transition from a non-aggressive to an aggressive subtype. Conclusions: Post PDT recurrences appear to display an increased histological aggressiveness, although the latter may reflect the natural course of tumor progression. Despite the presence of potential biases, our study raises the possibility that PDT favors the selection of more aggressive tumor cells. Better systematic large-scale follow-up studies are required to assess the exact frequency and histological types of BCC recurrences after PDT.

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Prevalence of Underdiagnosed Aggressive Non-Melanoma Skin Cancers Treated with Mohs Micrographic Surgery

Abstract: The authors have indicated no significant interest with commercial supporters.

Cited by 42 publications

References 6 publications

Accuracy of biopsy sampling for subtyping basal cell carcinoma

Accuracy of biopsy sampling for subtyping basal cell carcinoma

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

Facial Basal Cell Carcinomas Recurring after Photodynamic Therapy: A Retrospective Analysis of Histological Subtypes

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