Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma

Roozeboom, Marieke H.; Mosterd, Klara; Winnepenninckx, Véronique; Nelemans, Patty J.; Kelleners‐Smeets, Nicole W.J.

doi:10.1111/j.1468-3083.2012.04608.x

Cited by 57 publications

(50 citation statements)

References 23 publications

(71 reference statements)

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“…These findings suggest that preoperative histological subtype determination might be useful to indicate when wider clinical tumor-free excision margins are needed. Although in 1 out of 6 BCCs the most aggressive growth pattern is missed by the preoperative biopsy (i.e., sampling error), a biopsy was shown to be more sensitive and more specific than the clinical diagnosis on the histological subtype [13,14].…”

Section: Discussionmentioning

confidence: 99%

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Ramdas

Lee

Beck³

et al. 2018

Dermatology

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Background: Due to the increasing incidence of basal cell carcinoma (BCC) and rising health care costs, health care insurance companies seek ways to shift skin surgery for BCC from secondary to primary care. Objectives: To study the differences in complete excision of BCC by general practitioners (GPs), dermatologists, and plastic surgeons. Methods: A retrospective cross-sectional study of pathology records of 2,986 standard excisions of primary BCCs performed by a GP, dermatologist, or plastic surgeon in the area of Southwest Netherlands between 2008 and 2014. To compare the risk of an incomplete BCC excision between the specialties, the odds ratio (OR) was used adjusted for patient age, sex, tumor site, size, and histological subtype. Results: BCCs were completely excised by GPs in 70%, which was lower than the 93% by dermatologists and 83% by plastic surgeons (p < 0.001). Compared to the dermatologist, BCCs which were excised by a GP were 6 times higher at risk of an incomplete excision (adjusted OR 6, 95% CI 5–8) and 2 times higher at risk when excised by a plastic surgeon (adjusted OR 2, 95% CI 2–3). Conclusion: BCCs were more often completely excised by dermatologists than by GPs and plastic surgeons. Dermatologists probably perform better because of their extensive training and high experience in BCC care. To minimize incomplete BCC excision, GPs should receive specific training before the shift of BCC care from secondary to primary care is justifiable.

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Section: Discussionmentioning

confidence: 99%

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Ramdas

Lee

Beck³

et al. 2018

Dermatology

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“…On the basis of the best available literature, the most useful stratification of BCC is provided by the National Comprehensive Cancer Network (NCCN) Guidelines (for recommendation, see Table II; for level of evidence/strength of recommendation, see Table III). 2,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The NCCN stratification, listed in Table IV, takes both clinical and pathologic parameters into account and is based on a combination of available evidence and expert multidisciplinary opinion, including representatives from dermatology, dermatopathology, head and neck surgery, plastic surgery, and surgical, radiation, and medical oncology. Treatment recommendations throughout the current guidelines are based on this stratification.…”

Section: Grading and Stagingmentioning

confidence: 99%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

312

219

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Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed. ( J Am Acad Dermatol

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“…In contrast to basal cell carcinoma (BCC), the correlation between the histological findings of punch biopsies and surgical excision in cSCC has not been documented in the literature (21)(22)(23)(24). In cSCC, not only the correla- Table I.…”

mentioning

confidence: 99%

Correlation Between Histological Findings on Punch Biopsy Specimens and Subsequent Excision Specimens in Cutaneous Squamous Cell Carcinoma

Westers-Attema¹,

Joosten²,

Roozeboom³

et al. 2015

Acta Derm Venerol

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Diagnosis and subsequent treatment of cutaneous squamous cell carcinoma are frequently based on punch biopsies. Regarding the current TNM classification and stage grouping for cutaneous squamous cell carcinoma, it is important to identify the high-risk features (infiltration depth > 4 mm, perineural and/or lymphovascular invasion and poor differentiation). This study investigates the agreement of histological high-risk features and TNM grouping stage on 3 mm punch biopsies and subsequent surgical excision in 105 patients diagnosed with cutaneous squamous cell carcinoma. On punch biopsy, infiltration depth > 4 mm is not identified in 83.3% (30/36), perineural invasion in 90.9% (10/11) and poor differentiation in 85.7% (6/7) of cases. The TNM stage was underestimated on punch biopsy in 15.4% (16/104). This study shows that on a 3 mm punch biopsy, high-risk features in cSCC can remain undetected and that the actual TNM stage is not identified in 1 out of 6 tumours.

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Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma

Abstract: Dermatologists and other physicians have to be aware of the limited diagnostic value of a punch biopsy to determine the histological BCC subtype of the whole lesion. Misdiagnosis of the subtype will lead to undertreatment in one of six primary BCCs.

Cited by 57 publications

References 23 publications

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Guidelines of care for the management of basal cell carcinoma

Correlation Between Histological Findings on Punch Biopsy Specimens and Subsequent Excision Specimens in Cutaneous Squamous Cell Carcinoma

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