05 Aug Basal Cell Skin Cancer: Algorithm May Help Identify More Aggressive Types Before Surgery
MedicalResearch.com Interview with:
Hannah Ceder
Department of Dermatology and Venereology
Institute of Clinical Sciences, Sahlgrenska Academy
University of Gothenburg
Gothenburg, Sweden
MedicalResearch.com: What is the background for this study?
Response: Many facial basal cell carcinomas (BCCs) are currently excised without prior biopsy, often resulting in incomplete surgical excisions. This practice is concerning because histopathologically high-risk BCCs have an increased risk of postoperative recurrence, necessitating a more meticulous surgical approach.
For facial high-risk BCCs, Mohs micrographic surgery is the recommended treatment method. Given these challenges, there is a clear need for simple, preoperative methods to help physicians identify high-risk tumors. By improving preoperative assessment, these methods could enhance treatment planning, reduce incomplete excisions, and optimize the use of Mohs micrographic surgery for high-risk cases.
MedicalResearch.com: What are the main findings?
Response: Integration of both clinical and dermoscopic features (including novel features such as topography and vessels within ulceration) are essential to improve subtype prediction of facial BCCs. The four criteria most strongly associated with high-risk subtypes were:
1) “bumpy”topography,
2) ill-defined borders,
3) presence of a white porcelain area, and
4) presence of vessels within ulceration.
MedicalResearch.com: Do most basal cells have surface blood vessels and a pearly nodularity?
Response: Yes and no. Most BCCs have blood vessels but in high-risk BCCs they are often focused in comparison with superficial BCCs where we see unfocused vessels. A novel feature we also saw in high risk BCCs were vessels within ulceration.
White porcelain areas or pink-white areas are most seen in high-risk BCCs, in our study,38.6% compared to in superficial 12.5% and nodular 15.8%.
MedicalResearch.com: What should readers take away from your report?
Response: If the BCC has a combination of 1) “bumpy” topography, 2) ill-defined borders, 3) presence of a white porcelain area or 4) presence of vessels within ulceration, think of the possibility that it might be a high-risk BCC and take a biopsy before surgery.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Moving forward, we plan to evaluate the proposed algorithm using consecutive cases collected prospectively from various centers.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures
Response: Our proposed diagnostic algorithm, which integrates clinical and dermoscopic findings, provides a practical method for clinicians to predict high-risk histopathological subtypes preoperatively. This can hopefully lead to more accurate surgical planning, helping to identify which tumors should be biopsied preoperatively to determine those requiring Mohs surgery.
In the long term, we hope the result will be fewer incomplete excisions, fewer recurrences of high-risk BCCs on the face, and reduced suffering for the patient. Our motto is that the first treatment should be the last treatment.
No disclosures
Citation: Ceder H, Backman E, Marghoob A, Navarrete-Dechent C, Polesie S, Reiter O, Paoli J. Importance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas. Dermatol Pract Concept. 2024 Jul 1. doi: 10.5826/dpc.1403a212. Epub ahead of print. PMID: 38934710.
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Last Updated on August 5, 2024 by Marie Benz MD FAAD