The Use of Dermoscopy in the Delineation of Basal Cell Carcinoma for Mohs Micrographic Surgery

Litaiem, Noureddine; Hayder, Faten; Benlagha, Imene; Karray, M.; C, Dziri; Zéglaoui, Faten

doi:10.5826/dpc.1204a176

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…A recent systematic review demonstrated that there was no statistically significant difference in the proportion of total margin clearance on the first MMS stage between basal cell carcinomas removed using dermoscopy-guided MMS and those that had curettage or visual inspection. 19 Despite the mixed evidence for the role of dermoscopy in MMS, we believe that dermoscopy helps with lateral tumor delineation and biopsy site identification.…”

Section: Discussionmentioning

confidence: 77%

Squamous Cell Carcinoma in Situ Achieves Tumor Clearance in More Mohs Stages Than Invasive Squamous Cell Carcinoma

Kim,

Khan,

Papachristou

et al. 2023

Dermatol Surg

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BACKGROUND Squamous cell carcinoma in situ (SCCIS) has more subclinical lateral extension than invasive squamous cell carcinomas (SCC). OBJECTIVE To determine whether it takes a greater number of Mohs stages for clearance of SCCIS compared with SCC and whether the difference in final defect size and clinical size is larger in SCCIS than SCC. METHODS All Mohs micrographic surgery cases of SCCIS and SCC performed between January 2011 and December 2021 were identified. Number of Mohs stages were recorded and difference in final defect size and initial clinical size were calculated for SCCIS and SCC. RESULTS 4,363 cases were included, 1,066 SCCIS and 3,297 invasive SCC. The initial clinical size, final defect size, and the size difference were similar between SCCIS and SCC groups. However, SCCIS underwent more Mohs stages to achieve tumor clearance than invasive SCCs (1.5 ± 0.7 vs 1.4 ± 0.7 respectively, p < .001). In fact, 71% of SCCs were cleared after 1 Mohs stage compared with 61.1% of SCCIS. CONCLUSION These findings support that SCCIS has more subclinical lateral extension and therefore is appropriate for Mohs surgery.

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Section: Discussionmentioning

confidence: 77%

Squamous Cell Carcinoma in Situ Achieves Tumor Clearance in More Mohs Stages Than Invasive Squamous Cell Carcinoma

Kim,

Khan,

Papachristou

et al. 2023

Dermatol Surg

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“…Theoretically, dermoscopic examination would allow for more accurate initial margin mapping, allowing for a decrease in incidental findings, fewer Mohs layers, and narrower overall excision size. In 2022, Litaiem and colleagues 10 conducted a systematic review and meta-analysis, which compared dermoscopic examination before Mohs surgery with curettage and preoperative visual inspection. The authors found mixed results with lateral margin clearance being greater, but no difference in total margin clearance after the first MMS stage in the dermoscopy group as compared with the control groups (curettage and visual inspection).…”

Section: Discussionmentioning

confidence: 99%

Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor

Darsha,

Pousti,

Loh

et al. 2024

Dermatol Surg

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BACKGROUND Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest. OBJECTIVE Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery. METHODS A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed. RESULTS Of 13,464 Mohs surgery cases, 4.53% (n = 610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% (n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% (n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications. CONCLUSION Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness.

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“…In a recent meta-analysis, dermoscopy revealed no statistically significant differences in the proportion of complete margin clearance on the first MMS stage between BCCs treated with dermoscopy-guided MMS and those who underwent curettage or visual inspection. However, lateral margin involvement was significantly lower in BCCs that had dermoscopy-guided MMS [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Combining Reflectance Confocal Microscopy, Optical Coherence Tomography, and Ex-Vivo Fluorescence Confocal Microscopy for Margin Assessment in Basal Cell Carcinoma Excision

Michelini,

Mandel,

Ardigò

et al. 2024

Dermatology Practical &Amp; Conceptual

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Introduction: Recent developments of noninvasive, high-resolution imaging techniques, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), have enhanced skin cancer detection and precise tumor excision particularly in highly aggressive and poorly defined basal cell carcinomas (BCCs) Objectives: The aim of this pilot study is to assess feasibility and reproducibility of a systematic clinical workflow combining noninvasive (RCM-OCT) and invasive fluorescence confocal microscopy (FCM) imaging modalities in pre- and intra-surgical evaluations of lateral and deep margins of BCC. Methods: Superficial incisions were made 2 mm beyond the clinical-dermoscopic BCC margins. Lateral margins were then explored with OCT and RCM. In positive margins, a further cut was made 2 mm distal from the previous. A final RCM/OCT-based double-negative margin was drawn around the entire perimeter of the lesion before referring to surgery. The freshly excised specimen was then examined with FCM (ex-vivo) for the evaluation of the deep margin. Histopathologic examination eventually confirmed margin involvement. Results: The study included 22 lesions from 13 patients. At the end of the study, 146 margins—106 negative (73%) and 40 positive (27%) at RCM/OCT—were collected. RCM/OCT margin evaluation showed an overall sensitivity of 100%, a specificity of 96.3%. The overall positive margins diagnostic accuracy was 98.2%. Reproducibility was evaluated on recorded images and the raters showed a substantial inter-observer agreement on both RCM (κ =0.752) and OCT images (κ =0.724). Conclusions: The combined RCM/OCT/FCM ex-vivo approach noninvasively facilitates the presurgical and intrasurgical lateral and deep margin assessment of poorly defined BCCs.

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The Use of Dermoscopy in the Delineation of Basal Cell Carcinoma for Mohs Micrographic Surgery

Cited by 7 publications

References 24 publications

Squamous Cell Carcinoma in Situ Achieves Tumor Clearance in More Mohs Stages Than Invasive Squamous Cell Carcinoma

Squamous Cell Carcinoma in Situ Achieves Tumor Clearance in More Mohs Stages Than Invasive Squamous Cell Carcinoma

Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor

Combining Reflectance Confocal Microscopy, Optical Coherence Tomography, and Ex-Vivo Fluorescence Confocal Microscopy for Margin Assessment in Basal Cell Carcinoma Excision

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