Preoperative Evaluation through Dermoscopy and Reflectance Confocal Microscopy of the Lateral Excision Margins for Primary Basal Cell Carcinoma.

Mihai Lupu,Ana Caruntu,Constantin Caruntu,Vlad Mihai Voiculescu,Tiberiu Tebeica

doi:10.3390/diagnostics11010120

Abstract

Complete removal of malignant skin lesions with minimal impact on the aesthetic and functional aspects is the ideal of every dermatologic surgeon. Incomplete surgical excisions and tumor recurrences of basal cell carcinomas (BCC) commonly occur due to the subclinical extension of tumor lateral margins. Presently, the lateral excision margins for BCC cannot be objectively assessed preoperatively, dermoscopy proving to be relatively inefficient in this respect. The question is whether BCC lateral excision margins can be precisely determined preoperatively through the use of complementary non-invasive imaging techniques such as dermoscopy and reflectance confocal microscopy (RCM), thus permitting the complete removal of the lesion in a single stage, estimation of the post-excisional defect, and planning an appropriate reconstruction, especially in medical centers where Mohs micrographic surgery is not available. We present the results of a prospective, histopathologically controlled study designed to determine the feasibility of preoperative, non-invasive, in vivo evaluation of the lateral excision margins for primary basal cell carcinoma, through dermoscopy and RCM.

Highlights

The main objective of dermatologic surgery is to completely remove malignant skin lesions while having a minimal aesthetic and functional impact
The main objective of this study is to determine the viability of preoperative non-invasive in vivo evaluation, through dermoscopy and reflectance confocal microscopy, of the lateral excision margins for primary basal cell carcinoma
Patients who presented with comorbidities that would encumber the imaging protocol; residual tumors or recurrences after surgical treatments; tumors previously treated with topical therapy; tumors previously treated with photodynamic therapy or radiotherapy; tumors in the proximity of scars, tattoos, or extending to mucosal surfaces; lesions in anatomical regions inaccessible to dermoscopic or confocal imaging were excluded from the study

Summary

Introduction

The main objective of dermatologic surgery is to completely remove malignant skin lesions while having a minimal aesthetic and functional impact. The question behind this study is whether basal cell carcinoma lateral excision margins can be precisely determined preoperatively through the use of dermoscopy and reflectance confocal microscopy (RCM). This would allow for the complete removal of the lesion in one stage, the estimation of the size of the post-surgical defect, and devising an appropriate reconstruction plan, especially in centers where Mohs micrographic surgery is not available. This approach has been considered before and a methodology is already in place [3]

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Conclusion