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

Navarrete-Dechent C.; Cordova M.; Aleissa S.; Liopyris K.; Dusza, S. W.; Phillips W.; Rossi A.M.; Lee E.H.; Marghoob, A. A.; Nehal K.S.

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-mu m 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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Título según WOS: Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study
Título según SCOPUS: Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study
Título de la Revista: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volumen: 81
Número: 2
Editorial: MOSBY-ELSEVIER
Fecha de publicación: 2019
Página de inicio: 417
Página final: 426
Idioma: English
DOI:

10.1016/j.jaad.2019.02.049

Notas: ISI, SCOPUS