Characteristics of Superficial Basal Cell Carcinomas Containing More Aggressive Subtypes Journal of Drugs in Dermatology

TAKE-HOME MESSAGE

• The authors conducted a single-center, retrospective review to evaluate the concordance between an initial biopsy of superficial basal cell carcinoma (sBCC) and the final BCC subtype after Mohs micrographic surgery (MMS) or excision with frozen sections (EFS). They identified 117 cases of sBCC with residual BCC noted during treatment with MMS or EFS. In over a third of cases, the residual tumor was found to have a component of nodular, micronodular, or infiltrative BCC. Age >60 years and location on the head and neck were associated with reclassification of BCC subtype. Additionally, reclassified BCCs needed a significantly higher number of MMS stages to achieve clearance.

• Clinicians should recognize the limitations of biopsy when interpreting histopathologic results as lesions initially read as sBCC contained a concurrent and more aggressive BCC subtype in over a third of cases and this impacts treatment decisions. Further studies with a larger and more diverse patient population are needed.

– Alex  Noble, MD

Abstract 

BACKGROUND

The prognosis and treatment of basal cell carcinoma (BCC) are largely dependent on tumor subtype, which is typically determined by punch or shave biopsy. Data regarding concordance between BCC subtype on initial biopsy and final histopathology for Mohs micrographic surgery (MMS) or excision with frozen sections (EFS) are limited.

OBJECTIVES

To determine the concordance between initial biopsy and final MMS or EFS subtyping of BCC. We aim to investigate the incidence and clinical characteristics of lesions initially diagnosed as superficial BCC (sBCC) that are later found to have a nodular, micronodular, or infiltrative component.

METHODS

We conducted a retrospective review of all MMS or EFS cases performed at a single academic center from August 1, 2015 to August 31, 2017. Inclusion criteria were a biopsy-proven diagnosis of sBCC and presence of residual tumor following stage I of MMS or EFS. Fisher's exact test was used to evaluate significance of clinical characteristics and outcomes associated with the presence of a nodular, micronodular, or infiltrative BCC component.

RESULTS

A total of 164 MMS or EFS cases had an initial biopsy showing sBCC. Of these, 117 had residual BCC on stage I, and 43 (37%) were found to have a nodular, micronodular, or infiltrative component. Significant predictors of reclassified BCC subtype included age over 60 years (P=0.006) and location on the head or neck (P=0.043). Reclassified lesions required significantly more stages of MMS to clear (P=0.036). Shave biopsy was used to diagnose 114 (98%) of the included cases.

CONCLUSIONS

Over one third of shave biopsies that initially diagnosed sBCC failed to detect a nodular, micronodular, or infiltrative component. Management of biopsy-proven sBCC should take into account the possible presence of an undiagnosed deeper tumor component with appropriate margin-assessment treatment modalities when clinically indicated. J Drugs Dermatol. 2021;20(3):283-288. doi:10.36849/JDD.5383.

Journal of Drugs in Dermatology

Characteristics of Superficial Basal Cell Carcinomas Containing More Aggressive Subtypes on Final Histopathologic Diagnosis

J Drugs Dermatol 2021 Mar 01;20(3)283-288, GK Sohn, K Keniston, S Kannan, B Hinds, SIB Jiang 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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