Correlation between histologic findings on punch biopsy specimens and subsequent excision specimens in recurrent basal cell carcinoma

Basal cell carcinoma on the ear is more likely to be of an aggressive phenotype in both men and women

“…These findings speak to the notion that there is value in designating the histologic subtype of BCC, as the clinical behavior clearly differs among the variants. 8,9 It is therefore customary at our institution to designate the subtype of all BCCs diagnosed.…”

“…Most authorities follow this breakdown when referring to subclassification of BCC, both from a histologic and clinical standpoint. 9,11,12 Statistical analysis was performed using Fisher exact test and odds ratios.…”

“…5,6 BCC has several variants with some subtypes considered to be more aggressive than others. [7][8][9] Numerous classification schema have been devised to subcategorize BCC, some of them containing upward of 20 variants. 10 However, these classifications have been refined with a general consensus suggesting that there are variants of BCC with a more indolent behavior compared with others that are considered more aggressive.…”

“…[12][13][14] The most important aspects of this discrimination are that the higherrisk subtypes are often more difficult to treat, and they are more likely to recur after treatment. 7,9,15 Owing to their tendency for deeper invasion and an increased likelihood for perineural invasion, 16 the higher-risk types are more difficult to treat because they often involve more extensive surgery, an increased number of stages when treated with Mohs micrographic surgery, 15,17 and not all treatment modalities are suitable for such tumors. 8,18,19 The distribution of BCC by age, subtype, and anatomic distribution was recently studied by Betti et al 20 They found that younger patients are less likely to present with BCCs on the head and neck compared with elderly patients, but there was no difference in the incidence in the more aggressive subtype morpheic (morpheaform or sclerosing) BCC between the age groups.…”

Guidelines of care for the management of basal cell carcinoma

“…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.…”