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Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study - 27/07/19

Doi : 10.1016/j.jaad.2019.02.049 
Cristian Navarrete-Dechent, MD a, b, Miguel Cordova, MD b, Saud Aleissa, MD b, Konstantinos Liopyris, MD a, Stephen W. Dusza, DrPH b, William Phillips, BS b, Anthony M. Rossi, MD b, Erica H. Lee, MD b, Ashfaq A. Marghoob, MD b, Kishwer S. Nehal, MD b,
a Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 
b Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 

Correspondence to: Kishwer S. Nehal, MD, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th St, New York, NY 10022.Dermatology ServiceDepartment of MedicineMemorial Sloan Kettering Cancer Center16 E 60th StNew YorkNY10022

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.

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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.
 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.
 Preliminary data from this manuscript were presented at the American Academy of Dermatology Annual Meeting, Washington, DC, March 1-5, 2019.
 Reprints not available from the authors.


© 2019  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 81 - N° 2

P. 417-426 - août 2019 Retour au numéro
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