Predictive value of margins in diagnostic biopsies of nonmelanoma skin cancers

Jackson, Julie; Kelly, Brent; Petitt, Matthew; Uchida, Tatsuo; Wagner, Richard F.

doi:10.1016/j.jaad.2011.09.027

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…10 The discrepancy between the results of that study and our own might be explained by the observation that residual SCC is more likely than BCC to regress following partial biopsy and is, therefore, less likely to be identified on subsequent excision. 11 Although a subset of the biopsies we encounter in our practice have been immediately followed by electrodessication and curettage, most neoplasms are biopsied without definitive treatment immediately following the biopsy; in many cases, we are not provided with information regarding the clinical procedure performed.…”

Section: Commentcontrasting

confidence: 62%

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

Schnebelen

Gardner²,

Shalin³

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-The practice of reporting margin status in biopsies is relatively unique to biopsies of the skin and highly variable among pathologists.Objective.-To address the accuracy of margin evaluation in shave biopsies of nonmelanoma skin cancers.Design.-We collected shave biopsies of squamous and basal cell carcinomas that appeared to have uninvolved margins on routine sign out. We obtained deeper levels on corresponding tissue blocks until blocks were exhausted and examined them for tumor at biopsy margins.Results.-Forty-seven consecutive cases were collected, including 20 squamous cell (43%) and 27 basal cell (57%) carcinomas. Eleven of 47 cases (23%) with negative margins at initial diagnosis demonstrated positive margins upon deeper-level examination. Margins of 8 of 27 basal cell carcinomas (30%) and 3 of 20 squamous cell carcinomas (15%) were erroneously classified as ''negative'' on routine examination.Conclusions.-No guidelines exist regarding the reporting of margins in nonmelanoma skin cancer biopsies, and reporting practices vary extensively among pathologists. We found that nearly one-quarter of positive margins in shave biopsies for cutaneous carcinomas are missed on standard histologic examination. Moreover, reporting of a positive margin may also be misleading if the clinician has definitively treated the skin cancer at the time of biopsy. For these reasons, and as routine exhaustion of all tissue blocks is impractical, the decision to include or exclude a comment regarding the margin status should be given conscious consideration, accounting for the clinical intent of the biopsy and any known information regarding postbiopsy treatment.

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Section: Commentcontrasting

confidence: 62%

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

Schnebelen

Gardner²,

Shalin³

2016

Archives of Pathology &Amp; Laboratory Medicine

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“…4 Direct comparisons of residual cancer rates in excisions of KA and well-differentiated SCC lesions are limited; however, Jackson et al reported similar residual cancer rates of 21% in KAs (n ¼ 24) and 22% in well-differentiated SCCs (n ¼ 59). 5 In our study, older age is associated with residual cancer. Jackson et al reported a similar trend, with residual cancer rates of 42% in patients $60 years and 26% in patients \60 years (P ¼ .089).…”

Section: Keratoacanthomas: a Review Of Excised Specimenssupporting

confidence: 48%

“…Jackson et al reported a similar trend, with residual cancer rates of 42% in patients $60 years and 26% in patients \60 years (P ¼ .089). 5 Although Swetter et al did not find age to be a risk factor, their veteran population was older, making comparisons less reliable. 4 They also found location to be a risk factor for residual tumor in nonmelanoma skin cancer, but they did not separate out SCC.…”

Section: Keratoacanthomas: a Review Of Excised Specimensmentioning

confidence: 94%

Keratoacanthomas: A review of excised specimens

Gibbons

Ernst

Patel

et al. 2019

Journal of the American Academy of Dermatology

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“…It has been repeatedly established that recurrences of basal cell carcinoma occur even when margins of the original biopsy are reported as negative; in contrast, many reexcisions of margin-positive basal cell carcinomas contain no residual tumor. 16,17 Given this, one must exercise caution when interpreting and reporting margins on basal cell carcinoma.…”

Section: Reporting Margins For Basal Cell Carcinomamentioning

confidence: 99%

Practical Strategies to Improve the Clinical Utility of the Dermatopathology Report

Trotter¹,

Au²,

Naert

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Dermatologists and subspecialty dermatopathologists, working together over many years, develop a common understanding of clinical information provided on the requisition and of terminology used in the pathology report. Challenges arise for pathologists without additional subspecialty training in dermatology/dermatopathology, and for any pathologist reporting skin biopsies for nondermatologists such as general practitioners or surgeons.Objective.-To provide practical strategies to improve efficiency of dermatopathology sign-out, at the same time providing the clinician with clear diagnostic and prognostic information to guide patient management.Data Sources.-The information outlined in this review is based on our own experiences with routine dermatopathology and dermatology practice, and review of Englishlanguage articles related to the selected topics discussed.Conclusions.-Using generic diagnoses for some benign lesions, listing pertinent negatives in the pathology report, and using logical risk management strategies when reporting on basal cell carcinoma, partial biopsies, or specimens with incomplete clinical information allow the pathologist to convey relevant and useful diagnostic information to the treating clinician.(Arch Pathol Lab Med. 2016;140:759-765; doi: 10.5858/ arpa.2015-0474-RA) D ermatologists and subspecialty dermatopathologists, working together over many years, develop a common language that marries the clinical information provided on the pathology requisition with the terminology used in the pathology report. Challenges arise for pathologists without additional subspecialty training in dermatology/dermatopathology, and for any pathologist reporting skin biopsies for nondermatologists such as general practitioners or surgeons.This review is targeted at general surgical pathologists who are reporting skin biopsies. The objective is to provide practical strategies to improve efficiency of dermatopathology sign-out, while providing the clinician with clear diagnostic and prognostic information to guide patient management. Strategies such as including pertinent negatives in a report and using generic diagnoses where appropriate are discussed. Apart from interpretative and diagnostic challenges, many pathologists face difficulties interpreting the limited clinical information that is often provided on the requisition. Communication failures between clinicians and pathologists have implications for pathologist efficiency as well as the quality and safety of patient care.1 Pathology reporting in the absence of complete clinical information or diagnosis of partial biopsy specimens is a significant risk to the patient and to the signout pathologist. We will discuss strategies to reduce this risk and communicate useful information to the treating clinician.The topics chosen reflect the authors' experience based on intradepartmental consultation with general surgical pathology colleagues faced with challenges in dermatopathology reporting.

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Predictive value of margins in diagnostic biopsies of nonmelanoma skin cancers

Cited by 14 publications

References 11 publications

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

Keratoacanthomas: A review of excised specimens

Practical Strategies to Improve the Clinical Utility of the Dermatopathology Report

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