最终病理诊断为侵袭性亚型的浅表性基底细胞癌的特征。

Characteristics of Superficial Basal Cell Carcinomas Containing More Aggressive Subtypes on Final Histopathologic Diagnosis.

出版信息

J Drugs Dermatol. 2021 Mar 1;20(3):283-288. doi: 10.36849/JDD.5383.

Abstract

BACKGROUND

The prognosis and treatment of basal cell carcinoma (BCC) are largely dependent on tumor subtype, which is typically determined by punch or shave biopsy. Data regarding concordance between BCC subtype on initial biopsy and final histopathology for Mohs micrographic surgery (MMS) or excision with frozen sections (EFS) are limited.

OBJECTIVES

To determine the concordance between initial biopsy and final MMS or EFS subtyping of BCC. We aim to investigate the incidence and clinical characteristics of lesions initially diagnosed as superficial BCC (sBCC) that are later found to have a nodular, micronodular, or infiltrative component.

METHODS

We conducted a retrospective review of all MMS or EFS cases performed at a single academic center from August 1, 2015 to August 31, 2017. Inclusion criteria were a biopsy-proven diagnosis of sBCC and presence of residual tumor following stage I of MMS or EFS. Fisher’s exact test was used to evaluate significance of clinical characteristics and outcomes associated with the presence of a nodular, micronodular, or infiltrative BCC component.

RESULTS

A total of 164 MMS or EFS cases had an initial biopsy showing sBCC. Of these, 117 had residual BCC on stage I, and 43 (37%) were found to have a nodular, micronodular, or infiltrative component. Significant predictors of reclassified BCC subtype included age over 60 years (P=0.006) and location on the head or neck (P=0.043). Reclassified lesions required significantly more stages of MMS to clear (P=0.036). Shave biopsy was used to diagnose 114 (98%) of the included cases.

CONCLUSIONS

Over one third of shave biopsies that initially diagnosed sBCC failed to detect a nodular, micronodular, or infiltrative component. Management of biopsy-proven sBCC should take into account the possible presence of an undiagnosed deeper tumor component with appropriate margin-assessment treatment modalities when clinically indicated. J Drugs Dermatol. 2021;20(3):283-288. doi:10.36849/JDD.5383.

摘要

背景

基底细胞癌（BCC）的预后和治疗在很大程度上取决于肿瘤亚型，而肿瘤亚型通常通过打孔或刮除活检来确定。关于 Mohs 显微外科手术（MMS）或冷冻切片切除（EFS）初始活检与最终组织病理学 BCC 亚型之间一致性的数据有限。

目的

确定初始活检与最终 MMS 或 EFS 对 BCC 亚型的一致性。我们旨在研究最初诊断为浅表基底细胞癌（sBCC）但后来发现存在结节、微结节或浸润成分的病变的发病率和临床特征。

方法

我们对 2015 年 8 月 1 日至 2017 年 8 月 31 日在一家学术中心进行的所有 MMS 或 EFS 病例进行了回顾性分析。纳入标准为活检证实的 sBCC 诊断和 MMS 或 EFS 第 I 期后存在残留肿瘤。Fisher 确切检验用于评估与存在结节性、微结节性或浸润性 BCC 成分相关的临床特征和结局的显著性。

结果

共 164 例 MMS 或 EFS 病例的初始活检显示 sBCC。其中，117 例在第 I 期有残留 BCC，43 例（37%）发现有结节、微结节或浸润性成分。重新分类的 BCC 亚型的显著预测因素包括年龄大于 60 岁（P=0.006）和头颈部位置（P=0.043）。重新分类的病变需要更多的 MMS 阶段才能清除（P=0.036）。114 例（98%）纳入病例采用刮除活检诊断。