Cristian Navarrete-Dechent1, Miguel Cordova2, Saud Aleissa2, Konstantinos Liopyris3, Stephen W Dusza2, William Phillips2, Anthony M Rossi2, Erica H Lee2, Ashfaq A Marghoob2, Kishwer S Nehal4. 1. Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 3. Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 4. Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: nehalk@mskcc.org.
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.
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.
Authors: Ethan Walker; Yiqiao Liu; InYoung Kim; David L Wilson; James P Basilion; Daniel L Popkin; Mark Biro; Sukanya Raj Iyer; Harib Ezaldein; Jeffrey Scott; Miesha Merati; Rachel Mistur; Bo Zhou; Brian Straight; Joshua J Yim; Matthew Bogyo; Margaret Mann Journal: Cancer Res Date: 2020-03-04 Impact factor: 12.701
Authors: Saud Aleissa; Cristian Navarrete-Dechent; Miguel Cordova; Aditi Sahu; Stephen W Dusza; William Phillips; Anthony Rossi; Erica Lee; Kishwer S Nehal Journal: J Am Acad Dermatol Date: 2019-10-18 Impact factor: 11.527
Authors: Cristian Navarrete-Dechent; Saud Aleissa; Miguel Cordova; Konstantinos Liopyris; Aditi Sahu; Anthony M Rossi; Erica H Lee; Kishwer S Nehal Journal: Arch Dermatol Res Date: 2020-02-04 Impact factor: 3.017
Authors: Cristian Navarrete-Dechent; Konstantinos Liopyris; Jilliana Monnier; Saud Aleissa; Lindsay M Boyce; Caterina Longo; Margaret Oliviero; Harold Rabinovitz; Ashfaq A Marghoob; Allan C Halpern; Giovanni Pellacani; Alon Scope; Manu Jain Journal: J Am Acad Dermatol Date: 2020-05-23 Impact factor: 11.527
Authors: Cristian Navarrete-Dechent; Miguel Cordova; Konstantinos Liopyris; Saud Aleissa; Milind Rajadhyaksha; Gil'ad Cohen; Ashfaq A Marghoob; Anthony M Rossi; Christopher A Barker Journal: J Am Acad Dermatol Date: 2020-08-20 Impact factor: 15.487