Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study - 27/07/19
Abstract |
Background |
Biopsy specimens from patients with basal cell carcinoma (BCC) can present to surgery with no clinically residual tumor, complicating treatment decisions.
Objective |
To evaluate reflectance confocal microscopy (RCM) for the assessment of residual BCC following biopsy.
Methods |
Consecutive patients with biopsy-proven BCC and no clinical evidence of residual tumor who had been referred for Mohs micrographic surgery were included. Biopsy sites were imaged with a handheld RCM device. On the basis of RCM evaluation, cases were labeled RCM positive or RCM negative. Mohs micrographic surgery was performed in all cases; margins and 15-μm serial vertical sectioning were evaluated.
Results |
A total of 61 patients were included (mean age, 61.7 years [standard deviation, 12.2 years]; range, 37-87 years); 60.7% were women. The mean lesion size was 5.1 mm (range, 3-12 mm); 73.8% of patients were positive on RCM, and 68.9% had residual BCC on histopathologic examination. The rates of RCM sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 68.4%, 86.6%, and 81.2%, respectively. Three cases of BCC (high-risk, infiltrative, and basosquamous) were missed with use of RCM. When high-risk subtypes were excluded (n = 5), sensitivity and negative predictive value were both 100%.
Limitations |
RCM can miss deep-seated residual tumor.
Conclusion |
RCM is a valuable tool for the evaluation of residual BCC following biopsy, with the potential to reduce unnecessary surgical procedures.
Le texte complet de cet article est disponible en PDF.Key words : basal cell carcinoma, biopsy, dermoscopy, Mohs micrographic surgery, reflectance confocal microscopy, residual, surgery
Abbreviations used : BCC, CI, RCM, SD
Plan
| Funding sources: Supported in part by a grant from the National Cancer Institute/National Institutes of Health (P30-CA008748) made to Memorial Sloan Kettering Cancer Center. |
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| Disclosure: Dr Rossi has no relevant conflicts of interest related to this manuscript but has served on advisory boards, served as a consultant, or given educational presentations for Allergan Inc, Galderma Inc, Evolus Inc, Elekta, Biofrontera, Quantia, Merz Inc, Dynamed, Skinuvia, and Perf-Action. Dr Marghoob has received honoraria from 3GEN for dermoscopy lectures, royalties from publishing companies for books and book chapters, dermoscopy equipment for testing and feedback, and payment from the American Dermoscopy Meeting for organizing and lecturing at the annual meeting. Dr Nehal has received royalties from publishing companies for books and book chapters. Dr Navarrete-Dechent, Dr Cordova, Dr Aleissa, Dr Liopyris, Dr Dusza, Mr Phillips, and Dr Lee have no conflicts of interest to disclose. |
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| Preliminary data from this manuscript were presented at the American Academy of Dermatology Annual Meeting, Washington, DC, March 1-5, 2019. |
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| Reprints not available from the authors. |
Vol 81 - N° 2
P. 417-426 - août 2019 Retour au numéro
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