Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

Abstract

Background The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. Objectives a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. Methods Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. Results The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. Study limitations Retrospective nature, sample size, and biopsies performed by different professionals. Conclusions The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.

Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review)

“…It is most frequently used in high-risk tumors, with higher rates for long-term cure. This approach has a high success rate, with dermatopathologists and Mohs surgeons agreeing on surgical excision margin clearance ( 12 , 58 ).…”

High‐Frequency Ultrasound and Shear Wave Elastography in Quantitative Differential Diagnosis of High‐Risk and Low‐Risk Basal Cell Carcinomas

“…Preoperative biopsy is mainly used to identify high‐risk from low‐risk BCC in clinical practice, but biopsy requires manipulation of the sample and often leave scarring, which is best avoided if BCC is susceptible to nonsurgical treatment, especially on the face 4 . Furthermore, preoperative biopsy represents only one sample of the tumor and may not include all the histological characteristics of the entire lesion 5 . A new noninvasive technique to determine the risk of BCC recurrence prior to treatment will undoubtedly be of great help in the development of clinical treatment plans.…”

“…4 Furthermore, preoperative biopsy represents only one sample of the tumor and may not include all the histological characteristics of the entire lesion. 5 A new noninvasive technique to determine the risk of BCC recurrence prior to treatment will undoubtedly be of great help in the development of clinical treatment plans.…”

Immunohistochemical expression of p53, Ki67, α-SMA, CD44 and CD31 in different histological subtypes of basal cell carcinoma

“…Indolent subtypes, including superficial and nodular BCC, are described as well demarcated nodules, either small or large, with peripheral palisading. Aggressive subtypes, including morpheaform, micronodular and metatypical, are less demarcated and have mitotic activity, increased cell necrosis and deeper growth [ 13 , 14 , 15 , 16 , 17 , 18 ]. Because of its contribution in maintaining genetic integrity, p53 is known as the “guardian of the genome”.…”