Histopathologic upgrading of nonmelanoma skin cancer at the time of Mohs micrographic surgery: A prospective review

Kyllo, Rachel; Staser, Karl; Rosman, Ilana S.; Council, M. Laurin; Hurst, Eva A.

doi:10.1016/j.jaad.2019.02.058

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…19 In up to one-third of cases, cutaneous neoplasms display even worse histopathological features ("tumor upgrading") at the analysis of MMS frozen sections compared with the pre-operative biopsy. 20 The experience illustrated in this study showed a BCC recurrence rate of 3.1% after MMS, compared to 14% for traditional surgery, P < .00001. In the literature, similar outcomes have been reported with a mean rate of relapses of 2.6% in MMS and 12% in traditional surgery.…”

Section: Discussionmentioning

confidence: 55%

“…Indeed, in a very recent paper, some authors reported an incomplete excision rate of 4.6% in a large case series of 3911 BCCs treated with conventional surgery, morpheaform BCC on the nose or ear showing the highest rates (61.5% and 50% respectively) 19 . In up to one‐third of cases, cutaneous neoplasms display even worse histopathological features (“tumor upgrading”) at the analysis of MMS frozen sections compared with the pre‐operative biopsy 20 …”

Section: Discussionmentioning

confidence: 99%

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It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Dika

Veronesi

Patrizi

et al. 2020

Dermatologic Therapy

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Basal cell carcinoma (BCC) is the most common variety of non‐melanoma skin cancer and its incidence is increasing worldwide. The centrofacial sites (area H) are considered a high‐risk factor for BCC local recurrence. Mohs micrographic surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins and is a good treatment option when tissue conservation is required for esthetic or functional reasons or for high‐risk lesions. The present study aimed to evaluate the recurrence rate of head and neck high‐risk BCCs comparing MMS vs conventional surgical excision. Clinical data of patients diagnosed from September 2014 to March 2017, referring to the Dermatology Unit of the Policlinico Sant'Orsola‐Malpighi, University of Bologna, were retrospectively evaluated (285 treated with MMS and 378 treated with traditional surgery). Of the 285 patients treated with MMS, 9 experienced a recurrence (3.1%). Of the 378 patients treated with traditional surgery, 53 relapsed (14%), 13 of whom presented residual tumor on the deep or lateral margins of the main surgical specimen. Our study confirms the trend reported in the literature that MMS represents the best treatment option for high‐risk BCCs arising in the head and neck region or presenting as a recurrence (P < .00001). Many more MMS centers and more trained dermatologists are needed worldwide in order to deal with the increasing number of BCC diagnosed every year.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Dika

Veronesi

Patrizi

et al. 2020

Dermatologic Therapy

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“…Prior studies have noted that a substantial amount of histologic upgrading between original biopsy and Mohs surgery occurs, particularly in immunosuppressed patients. 16 Thus, many tumors in patients with CLL categorized as a less aggressive subtype on biopsy are likely to be deemed more aggressive during Mohs histopathologic analysis. Our study results are intended to guide preoperative counseling of patients with CLL with BCC/SCC/SCCIS, where the final histologic subtype is likely yet to be determined at the time of Mohs surgery.…”

Section: Discussionmentioning

confidence: 99%

Operative expectations for Mohs surgery in patients with chronic lymphocytic leukemia: A multicenter retrospective cohort study

Hamel¹,

Phillipps²,

Nisar³

et al. 2023

JAAD International

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“…16 Ten to thirty-three percent of nonmelanoma skin cancers are found to be more aggressive during MMS than indicated on biopsy, and 10.5% to 12.1% of CSCC are upstaged during MMS. [12][13][14][15]17 When analyzed during MMS, frozen debulk specimens allow for real-time characterization of CSCC, including measurement of BD. In the United States, Breslow measurements are not routinely performed on biopsies of CSCC nor during MMS, despite their inclusion in the AJCC8 staging system.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility of Debulk Specimens During Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma

et al. 2021

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BACKGROUND Limited literature exists regarding whether intraoperative analysis of frozen debulk specimens during Mohs micrographic surgery (MMS) improves identification of high-risk features (HRF) of cutaneous squamous cell carcinoma (CSCC). OBJECTIVE Primary: identification of new HRF on debulk specimens. Secondary: CSCC upstaged after considering debulk data. MATERIALS AND METHODS A single-center, retrospective cohort study of patients with biopsy-proven CSCC treated by MMS with intraoperative frozen debulk analysis. Restricted (poor differentiation, new perineural invasion $0.1 mm, and Breslow depth .6 mm) and nonrestricted (any worsened tumor differentiation, any new perineural invasion, and Breslow depth .2 mm) analyses were performed. RESULTS In restricted analysis, 3.94% of cases had 1 new HRF on debulk analysis. In nonrestricted analysis, 32.9% of cases had $1 new HRF; 7.6% increased by 2 HRF. Approximately 2.0% of cases were upstaged by American Joint Committee on Cancer system, eighth edition criteria, 1.4% by Brigham and Women's Hospital. Tumor size $2 cm, male sex, and moderate differentiation on biopsy were significantly associated with new HRF identified on debulk analysis. CONCLUSION Intraoperative frozen debulk analysis can reveal HRF of CSCC not seen on biopsy or MMS stages, particularly among tumors $2 cm. American Joint Committee on Cancer system, eighth edition T2 tumors were most likely to be upstaged. Identification of new HRF on debulk analysis can improve CSCC staging and may impact patient treatment and follow-up.

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Histopathologic upgrading of nonmelanoma skin cancer at the time of Mohs micrographic surgery: A prospective review

Cited by 15 publications

References 30 publications

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Operative expectations for Mohs surgery in patients with chronic lymphocytic leukemia: A multicenter retrospective cohort study

Utility of Debulk Specimens During Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma

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