Superficial basal cell carcinoma, think deeper: Step sectioning of skin biopsy specimens yields 14% more aggressive subtypes
Because of different therapeutic regimens for superficial and non-superficial basal cell carcinomas (BCCs), accurate histopathological examination of a punch biopsy to determine its subtype is essential. The aim of the current study was to evaluate the additional yield of a more extensive step-secti...
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| Veröffentlicht in: | PloS one 2022-01, Vol.17 (1), p.e0256149 |
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| description | Because of different therapeutic regimens for superficial and non-superficial basal cell carcinomas (BCCs), accurate histopathological examination of a punch biopsy to determine its subtype is essential. The aim of the current study was to evaluate the additional yield of a more extensive step-section method to that of a standard histologic examination at 4 levels.
Data for this prospective study was obtained from the Pathology department of a Dutch tertiary hospital. Biopsy specimens of subsequent patients from March 2019 to June 2020 were sectioned to 8-levels instead of the regular 4-levels. Only patients with a superficial BCC subtype in the first 4-levels of sectioning were included (n = 100). After 8-level sectioning, it was recorded in which level (5-8) a more aggressive BCC component was found (i.e. nodular, infiltrative, or micronodular). Patients were followed-up to evaluate further treatment, and in case of excision, the excision specimen was reviewed to determine the BCC subtype. A logistic regression was performed to assess characteristics associated with a more aggressive BCC component in levels 5-8.
In 14 patients (14%) a more aggressive component was found in levels 5-8, all with a nodular component. Thirteen of these patients underwent excision, confirming a more aggressive BCC subtype. Of the 86 patients that had no deeper BCC component in levels 5-8, 26 (30.2%) underwent excision; In 4 patients no residual BCC was found, in 15 patients superficial BCC, and in 7 a more aggressive BCC subtype (1 nodular and 6 a combination of superficial/nodular/infiltrative). In multivariable analysis, head&neck localization was associated with finding a more aggressive BCC subtype in levels 5-8 (OR 6.41 (95%CI 1.56-26.30), p = 0.01)).
More extensive sectioning of superficial BCC biopsy specimens, especially in the head&neck area, leads to a more accurate BCC subtype diagnosis requiring different clinical management strategies. |
| doi_str_mv | 10.1371/journal.pone.0256149 |
| format | Article |
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Data for this prospective study was obtained from the Pathology department of a Dutch tertiary hospital. Biopsy specimens of subsequent patients from March 2019 to June 2020 were sectioned to 8-levels instead of the regular 4-levels. Only patients with a superficial BCC subtype in the first 4-levels of sectioning were included (n = 100). After 8-level sectioning, it was recorded in which level (5-8) a more aggressive BCC component was found (i.e. nodular, infiltrative, or micronodular). Patients were followed-up to evaluate further treatment, and in case of excision, the excision specimen was reviewed to determine the BCC subtype. A logistic regression was performed to assess characteristics associated with a more aggressive BCC component in levels 5-8.
In 14 patients (14%) a more aggressive component was found in levels 5-8, all with a nodular component. Thirteen of these patients underwent excision, confirming a more aggressive BCC subtype. Of the 86 patients that had no deeper BCC component in levels 5-8, 26 (30.2%) underwent excision; In 4 patients no residual BCC was found, in 15 patients superficial BCC, and in 7 a more aggressive BCC subtype (1 nodular and 6 a combination of superficial/nodular/infiltrative). In multivariable analysis, head&neck localization was associated with finding a more aggressive BCC subtype in levels 5-8 (OR 6.41 (95%CI 1.56-26.30), p = 0.01)).
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Data for this prospective study was obtained from the Pathology department of a Dutch tertiary hospital. Biopsy specimens of subsequent patients from March 2019 to June 2020 were sectioned to 8-levels instead of the regular 4-levels. Only patients with a superficial BCC subtype in the first 4-levels of sectioning were included (n = 100). After 8-level sectioning, it was recorded in which level (5-8) a more aggressive BCC component was found (i.e. nodular, infiltrative, or micronodular). Patients were followed-up to evaluate further treatment, and in case of excision, the excision specimen was reviewed to determine the BCC subtype. A logistic regression was performed to assess characteristics associated with a more aggressive BCC component in levels 5-8.
In 14 patients (14%) a more aggressive component was found in levels 5-8, all with a nodular component. Thirteen of these patients underwent excision, confirming a more aggressive BCC subtype. Of the 86 patients that had no deeper BCC component in levels 5-8, 26 (30.2%) underwent excision; In 4 patients no residual BCC was found, in 15 patients superficial BCC, and in 7 a more aggressive BCC subtype (1 nodular and 6 a combination of superficial/nodular/infiltrative). In multivariable analysis, head&neck localization was associated with finding a more aggressive BCC subtype in levels 5-8 (OR 6.41 (95%CI 1.56-26.30), p = 0.01)).
More extensive sectioning of superficial BCC biopsy specimens, especially in the head&neck area, leads to a more accurate BCC subtype diagnosis requiring different clinical management strategies.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Basal cell carcinoma</subject><subject>Biology and Life Sciences</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>Cancer</subject><subject>Carcinoma</subject><subject>Carcinoma, Basal Cell - classification</subject><subject>Carcinoma, Basal Cell - pathology</subject><subject>Dermatology</subject><subject>Diagnosis</subject><subject>Evaluation</subject><subject>Female</subject><subject>Histology</subject><subject>Humans</subject><subject>Localization</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Pathology</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Research and Analysis Methods</subject><subject>Sectioning</subject><subject>Skin</subject><subject>Skin - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El Sharouni, Mary-Ann</au><au>van Diest, Paul J</au><au>Blokx, Willeke A M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Superficial basal cell carcinoma, think deeper: Step sectioning of skin biopsy specimens yields 14% more aggressive subtypes</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-01-20</date><risdate>2022</risdate><volume>17</volume><issue>1</issue><spage>e0256149</spage><pages>e0256149-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Because of different therapeutic regimens for superficial and non-superficial basal cell carcinomas (BCCs), accurate histopathological examination of a punch biopsy to determine its subtype is essential. The aim of the current study was to evaluate the additional yield of a more extensive step-section method to that of a standard histologic examination at 4 levels.
Data for this prospective study was obtained from the Pathology department of a Dutch tertiary hospital. Biopsy specimens of subsequent patients from March 2019 to June 2020 were sectioned to 8-levels instead of the regular 4-levels. Only patients with a superficial BCC subtype in the first 4-levels of sectioning were included (n = 100). After 8-level sectioning, it was recorded in which level (5-8) a more aggressive BCC component was found (i.e. nodular, infiltrative, or micronodular). Patients were followed-up to evaluate further treatment, and in case of excision, the excision specimen was reviewed to determine the BCC subtype. A logistic regression was performed to assess characteristics associated with a more aggressive BCC component in levels 5-8.
In 14 patients (14%) a more aggressive component was found in levels 5-8, all with a nodular component. Thirteen of these patients underwent excision, confirming a more aggressive BCC subtype. Of the 86 patients that had no deeper BCC component in levels 5-8, 26 (30.2%) underwent excision; In 4 patients no residual BCC was found, in 15 patients superficial BCC, and in 7 a more aggressive BCC subtype (1 nodular and 6 a combination of superficial/nodular/infiltrative). In multivariable analysis, head&neck localization was associated with finding a more aggressive BCC subtype in levels 5-8 (OR 6.41 (95%CI 1.56-26.30), p = 0.01)).
More extensive sectioning of superficial BCC biopsy specimens, especially in the head&neck area, leads to a more accurate BCC subtype diagnosis requiring different clinical management strategies.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35051169</pmid><doi>10.1371/journal.pone.0256149</doi><tpages>e0256149</tpages><orcidid>https://orcid.org/0000-0003-4935-4670</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Basal cell carcinoma Biology and Life Sciences Biopsy Biopsy - methods Cancer Carcinoma Carcinoma, Basal Cell - classification Carcinoma, Basal Cell - pathology Dermatology Diagnosis Evaluation Female Histology Humans Localization Male Medicine and Health Sciences Middle Aged Pathology Patients Prospective Studies Research and Analysis Methods Sectioning Skin Skin - pathology Skin cancer Skin Neoplasms - classification Skin Neoplasms - pathology Tertiary Variables |
| title | Superficial basal cell carcinoma, think deeper: Step sectioning of skin biopsy specimens yields 14% more aggressive subtypes |
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