Prevalence of Underdiagnosed Aggressive Non-Melanoma Skin Cancers Treated with Mohs Micrographic Surgery

Abstract

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Accuracy of biopsy sampling for subtyping basal cell carcinoma

“…8 A more recent study showed a 51.1% accuracy rate between biopsy specimen and intraoperative examination of nonmelanoma skin cancers (BCC and squamous cell carcinoma). 10 A major and clinically important finding in our study is an overall 18% discordance rate between tumor subtype identification in the biopsy specimen and the composite BCC subtype. Sampling errors inherent in a small biopsy specimen of a large tumor would in part account for the observed discrepancy.…”

“…Similar failure to detect aggressive tumor subtypes has also been reported in Mohs excision specimens where 21.1% of the cases examined intraoperatively revealed an aggressive subtype that was not diagnosed by biopsy specimen. 10 Another notable finding is that 19% of the discordant cases were misidentified as infiltrative BCC in the biopsy specimen as a result of surface ulceration and reactive stromal changes. In these cases, we observed that the biopsy specimen showed nodular BCC with ulceration and stromal reaction that could have altered tumor morphology and mimicked an infiltrative growth pattern.…”

“…One study reported that only 10% of the initial biopsy specimens reported BCC with mixed subtypes when these tumors were actually found in 40% of Mohs resections, and a second study reported 51.1% concordance of biopsy specimen with Mohs excision. 8,10 Given the limited numbers of published studies evaluating the adequacy of biopsy specimen for BCC subtyping and the wide differences found in these reports, we undertook a study to systematically compare the tumor subtypes present in the initial biopsy specimen with the composite subtypes present in the biopsy specimen and wide excision. We determined the accuracy rate of biopsy specimen in correctly identifying all the subtypes present in a tumor, and evaluated trends toward misidentification of tumor subtypes.…”

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

“…Limited sampling during biopsy and pathology processing 6,7 fails to identify deeper and aggressive tumors in 1 of 6 cases, especially in mixed-histological subtypes 8,9 and in those superficial and nodular BCCs which have deeper components. 7,10 However, complete and accurate assessment of tumor subtype and depth is important for precise diagnosis and management, especially since skin cancer treatment guidelines list non-surgical options for the shallower and less-aggressive subtypes such as superficial and early nodular BCCs (depth ~0.2–0.5 mm) and surgical treatment for the aggressive and deeper subtypes such as micronodular, sclerosing and infiltrative. 3,4,11 Non-invasive optical imaging may help overcome these limitations and enable a more comprehensive assessment of lesions, and facilitate improved diagnosis, subtyping, and depth prediction.…”

Facial Basal Cell Carcinomas Recurring after Photodynamic Therapy: A Retrospective Analysis of Histological Subtypes

“…Finally, another source of errors is the questionable reliability of the initial biopsy examination. The latter can in fact miss the more aggressive component of a composite BCC in more than 40% of cases [11,17,18]. Composite aggressive and non-aggressive BCCs have been detected in 38.5% of a series of 1,039 cases [11].…”