Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA.
Veterans Affairs Medical Center, Brooklyn, NY, USA.
Arch Dermatol Res. 2021 Jul;313(5):319-325. doi: 10.1007/s00403-020-02151-5. Epub 2020 Oct 27.
The incidence of nonmelanoma skin cancer (NMSC) in the United States is increasing with approximately 3.6 million cases diagnosed per year. The staging and treatment of NMSC is guided by histologic subtype based on skin biopsy, along with other tumor-specific factors. However, a biopsy only represents a portion of the tumor, so there is a risk of upstaging at the time of definitive surgery. We conducted a review of the literature and found that a significant proportion of NMSC were upstaged during surgery. The rate of upstaging of basal cell carcinoma (BCC) was 7-31% and that of squamous cell carcinoma in situ (SCCIS) to squamous cell carcinoma (SCC) was 3-39%. Biopsy sampling error and variability in interpreting and reporting by dermatopathologists contribute to these discrepancies. It is pertinent to consider more comprehensive treatment modalities for tumors at high risk for upstaging. Diligence to identify tumors at higher risk for upstaging will allow clinicians to optimize management.
美国的非黑色素瘤皮肤癌（NMSC）发病率正在上升，每年约有 360 万例确诊病例。NMSC 的分期和治疗是根据皮肤活检的组织学亚型以及其他肿瘤特异性因素来指导的。然而，活检仅代表肿瘤的一部分，因此在确定性手术时存在升级分期的风险。我们对文献进行了回顾，发现相当一部分 NMSC 在手术中被升级分期。基底细胞癌（BCC）的升级分期率为 7-31%，原位鳞状细胞癌（SCCIS）到鳞状细胞癌（SCC）的升级分期率为 3-39%。活检取样误差和皮肤科病理学家在解释和报告方面的差异导致了这些差异。对于有升级分期高风险的肿瘤，考虑更全面的治疗方法是很重要的。努力识别有更高升级分期风险的肿瘤将使临床医生能够优化管理。
