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Assessing the Rate of Residual Basal Cell Carcinoma Among Excision Specimens After an Initial Shave Biopsy
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment.
OBJECTIVE
This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment.
METHODS AND MATERIALS
A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution.
RESULTS
Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC.
CONCLUSION
The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC.
Additional Info
A Large Percentage of Excision Specimens Show Residual Basal Cell Carcinoma: A Retrospective Chart Review
Dermatol Surg 2024 Sep 16;[EPub Ahead of Print], AJ Cecil, SP McClure, EW Seger, N Sultana, JA TateFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The aim of this study was to evaluate the rate of residual basal cell carcinoma (BCC) on excision specimens after initial shave biopsy to aid in decision-making in terms of the necessity of further treatment. The authors found that, among the 2117 excisions performed on previously biopsied BCCs, the rate of residual BCC in the excision specimens was 39.4%. Of course, the authors acknowledge that, if the excision specimens were leveled through the blocks, the likelihood of residual BCC would certainly be much higher than the calculated result. At any rate, the converse of their major conclusion is that an even larger proportion (60.6%) of the excision specimens showed no residual BCC. However, I question why we need a study to justify the subsequent treatment of a previously biopsied BCC — any good dermatologist knows that, unless there are apparent reasons to forgo treatment, a biopsy-proven BCC warrants treatment, lest one runs the risk of recurrence, subsequent growth, worsening cosmetic deformity, and so forth (including, extremely rarely, metastasis).
This study focused on BCCs that were evaluated by the shave method. However, for smaller well-defined BCCs on the trunk or extremities, my intent is often to cure the BCC at the time of biopsy with a shave removal. In this case, the biopsy specimen is processed differently than a shave biopsy, and the margins are actually evaluated. Upon determination of negative margins, I consider the BCC completely treated. Obviously, the same cannot be said about shave biopsies, as the margins cannot be reliably evaluated (yet, many practitioners — for some reason — still insist on reporting margins, and some dermatopathologists compliantly report whether or not the tumor is present at the margins, despite the unreliability of said information). In consideration of the much larger proportion of excision specimens that did not show residual BCC, it seems intuitively obvious that these were most likely found on the trunk and extremities, as a practitioner is more likely to remove the entire lesion with a more generous shave biopsy compared with biopsies performed on the face. The bottom line is that, regardless of whether one expects to find residual BCC in the excision specimen, a biopsy-proven BCC should be treated (unless there are overt reasons to refrain from treatment, such as extreme age, etc).