How Perfectly Do Biopsy Request Forms and Pathology Reports Adhere to Guidelines in Basal Cell Carcinoma? A...

Basal cell carcinoma (BCC) is classified as low-risk or high-risk, depending on clinical history, tumor characteristics, and histological features. Identifying high-risk cases is crucial for treatment planning. This study aims to evaluate adherence to current guidelines in biopsy request forms and pathology reports for BCC cases.

This retrospective study reviewed BCC pathology reports and biopsy requisition forms cases diagnosed between 2013 and 2023 at a tertiary care center. Clinical and pathological data, including patient demographics, lesion features, biopsy details, and histological findings, were analyzed for completeness.

A total of 851 BCC lesions were analyzed. Patient age, gender, type of biopsy, and lesion location were well-documented across request forms (100%, 100%, 99.1%, and 96.6%, respectively). Dermatologists documented lesion diameter more frequently (31.3% vs. 4.9%, p < 0.0001). Prior treatment status, radiotherapy history, and immunosuppression status were rarely noted (< 0.5%). Of 635 excisional specimens, only 16.4% were marked with sutures or ink. Histopathologic features were inconsistently documented in BCC pathology reports. Histologic subtype was reported in 24.7% of all cases, with significantly higher rates in excisional specimens (29.3%) compared to incisional (8.5%) and punch specimens (13.2%) (p < 0.00001). Lateral and deep margin status were documented in 94% and 92.4% of excisional specimens, respectively, while tumor thickness and level of invasion were rarely reported (11.7% and 1.1%).

Implementing standardized reporting systems, regular audits, and targeted training for clinicians and pathologists could significantly improve documentation practices. These measures would enhance data quality, streamline communication, and contribute to more accurate diagnoses, better treatment outcomes, and improved patient care.