Thomas J Knackstedt1, Jeoffry B Brennick2, Ann E Perry2, Zhongze Li3, Nicola A Quatrano1, Faramarz H Samie1. 1. Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 2. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 3. Biostatistics Shared Resource, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH, USA.
Abstract
BACKGROUND: Squamous cell carcinoma (SCC) in situ may be transected in a superficial biopsy, which makes it difficult to distinguish between in situ and invasive carcinoma. This study investigated the frequency of invasive SCC in transected SCC in situ referred for Mohs surgery. METHODS: A retrospective chart review was performed to identify subjects with biopsy-proven, transected SCC in situ referred for Mohs surgery. The incidence of invasion, histologic variables, preoperative and intraoperative correlations, and clinical factors were determined and recorded. RESULTS: Of 51 cases identified, five (9.8%) were found to harbor invasive SCC, 15 (29.4%) showed SCC in situ, and 28 (54.9%) showed evidence of scarring, inflammation, or actinic keratosis at the prior biopsy site. Invasive lesions required significantly more stages of Mohs surgery to obtain tumor clearance but were similar with regard to patient age, symptoms, and family and personal histories of skin cancer. Preoperative lesion size and duration were greater in invasive cases, but these differences did not reach statistical significance. CONCLUSIONS: A small number of transected SCCs in situ, to which the caveat "invasion cannot be ruled out" can be applied, have an invasive component that is identified during Mohs surgery. Definitive treatment choices should depend on the physician's impression, the clinical characteristics of the lesion, tumor location, patient comorbidities, and patient desires.
BACKGROUND:Squamous cell carcinoma (SCC) in situ may be transected in a superficial biopsy, which makes it difficult to distinguish between in situ and invasive carcinoma. This study investigated the frequency of invasive SCC in transected SCC in situ referred for Mohs surgery. METHODS: A retrospective chart review was performed to identify subjects with biopsy-proven, transected SCC in situ referred for Mohs surgery. The incidence of invasion, histologic variables, preoperative and intraoperative correlations, and clinical factors were determined and recorded. RESULTS: Of 51 cases identified, five (9.8%) were found to harbor invasive SCC, 15 (29.4%) showed SCC in situ, and 28 (54.9%) showed evidence of scarring, inflammation, or actinic keratosis at the prior biopsy site. Invasive lesions required significantly more stages of Mohs surgery to obtain tumor clearance but were similar with regard to patient age, symptoms, and family and personal histories of skin cancer. Preoperative lesion size and duration were greater in invasive cases, but these differences did not reach statistical significance. CONCLUSIONS: A small number of transected SCCs in situ, to which the caveat "invasion cannot be ruled out" can be applied, have an invasive component that is identified during Mohs surgery. Definitive treatment choices should depend on the physician's impression, the clinical characteristics of the lesion, tumor location, patient comorbidities, and patient desires.
Authors: Nádia Ghinelli Amôr; Carine Ervolino de Oliveira; Thaís Helena Gasparoto; Vanessa Garcia Vilas Boas; Graziela Perri; Ramon Kaneno; Vanessa Soares Lara; Gustavo Pompermaier Garlet; João Santana da Silva; Gislâine A Martins; Cory Hogaboam; Karen A Cavassani; Ana Paula Campanelli Journal: Oncotarget Date: 2018-07-20