Detection of High-Risk Histologic Features and Tumor Upstaging of Nonmelanoma Skin Cancers on Debulk Analysis: A Quantitative Systematic Review

BACKGROUNDHistologic analysis of tumor debulks from Mohs micrographic surgery (MMS) or wide local excision may lead to the detection of adverse features missed on initial biopsy. OBJECTIVEDetermine the incidence of (1) high-risk features on debulk analysis compared with initial biopsy and (2) upstag...

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Bibliographic Details
Published in:	Dermatologic surgery Vol. 43; no. 8; pp. 1003 - 1011
Main Authors:	Singh, Babu, Dorelles, Adriana, Konnikov, Nellie, Nguyen, Bichchau M
Format:	Journal Article
Language:	English
Published:	United States by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved 01-08-2017
Subjects:	Biopsy Carcinoma, Basal Cell - pathology Carcinoma, Basal Cell - surgery Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - surgery Humans Mohs Surgery Neoplasm Staging Skin Neoplasms - pathology Skin Neoplasms - surgery
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Summary:	BACKGROUNDHistologic analysis of tumor debulks from Mohs micrographic surgery (MMS) or wide local excision may lead to the detection of adverse features missed on initial biopsy. OBJECTIVEDetermine the incidence of (1) high-risk features on debulk analysis compared with initial biopsy and (2) upstaging of tumors on debulk analysis according to the American Joint Committee of Cancer-7th Edition (AJCC-7) and the Brigham and Womenʼs Alternative (BWH) staging criteria. MATERIALS AND METHODSA comprehensive search strategy using PubMed/MEDLINE, Web of Science, and EMBASE was conducted to identify articles published from 1960 to present that detail histology of initial biopsy and debulked tumor. RESULTSFourteen studies, encompassing 2,565 cases of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were included in the data extraction process. BCCs (30.9%) were reclassified from a low-risk histologic subtype to a high-risk subtype on debulk analysis (p < .001). Cases with perineural invasion (89.4%) were detected on debulk analysis. SCC tumors (9.1% and 11.1%) were upstaged according to the AJCC-7 and BWH Alternative criteria, respectively. Ninety percent of high-risk BWH T2b SCCs were inaccurately staged lower on initial biopsy. CONCLUSIONTumor debulk analysis in MMS may aid in the identification of additional high-risk features, thereby improving staging accuracy, treatment decisions and patient outcomes.
Bibliography:	SourceType-Scholarly Journals-1 ObjectType-Feature-4 ObjectType-Undefined-1 content type line 23 ObjectType-Review-2 ObjectType-Article-3
ISSN:	1076-0512 1524-4725
DOI:	10.1097/DSS.0000000000001146