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Dermoscopy-guided surgery in basal cell carcinoma
1Dermatology Unit Pathology Unit - Istituti Ospitalieri di Cremona, Cremona, Italy. g.a.caresana@virgilio.it
Summary
Dermoscopy allows for 2-mm excision margins in basal cell carcinoma (BCC) removal, achieving complete excision in 98.5% of cases. This method improves tumor margin detection compared to clinical examination alone.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Basal cell carcinoma (BCC) management typically requires 3-10 mm excision margins for radical excision.
- Achieving complete tumor removal is crucial for preventing recurrence.
Purpose of the Study:
- To evaluate if dermoscopy improves lateral border detection in BCCs.
- To determine if 2-mm excision margins guided by dermoscopy can achieve >95% radical excision rates.
Main Methods:
- Prospective study of 200 BCCs on the head and neck treated with 2-mm dermoscopically defined margins.
- Exclusion of specific BCC subtypes (morpheaform, recurrent, Gorlin-Goltz, inaccessible sites, superficial multifocal).
- Histological examination of all excised specimens with serial sections at 2-mm intervals.
Main Results:
- Complete excision was achieved in 197 out of 200 cases (98.5%) with 2-mm margins.
- Dermoscopy identified larger peripheral tumor extension in 34.5% of cases compared to clinical assessment.
- Clinical and dermoscopic measurements agreed on tumor extent in 65.5% of cases.
Conclusions:
- A 2-mm excision margin, guided by dermoscopy, is effective for achieving complete BCC excision in most cases.
- Dermoscopy enhances the accuracy of defining tumor borders, enabling smaller, yet adequate, surgical margins.
