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.

Subclinical dissemination in basal cell carcinoma: A case of 19-year latency to pulmonary metastasis

Systematic skin cancer screening in patients treated with biologics for chronic inflammatory rheumatic diseases: an 11-year experience.

We prospectively enrolled 131 lesions of 104 patients to confirm or rule out the diagnosis of BCC. Dermoscopy, line-field optical coherence tomography (LC-OCT), and Reflectance confocal microscopy 1500 (RCM) images were evaluated by one blinded expert (OM). The primary objective of this study was to assess the diagnostic performance of LC-OCT in lesions clinically suspicious for basal cell carcinoma (BCC), by determining the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this technique. Diagnostic performances were evaluated in two distinct real-life settings: lesions for which tissue-coupled reflectance confocal microscopy (RCM) served as the reference standard, and lesions for which histopathological examination following biopsy was used as the reference standard. The secondary objectives were to assess clinician confidence when using dermoscopy, LC-OCT, and RCM, and to estimate the agreement rate between LC-OCT and RCM findings. Design: Single-center, nonrandomized, blinded, prospective, observational study. OptiSkin. Patients with Fitzpatrick Skin Types I-IV between the ages of 29-92 years from OptiSkin are eligible for this study. Clinical, dermoscopic, and LC-OCT images were obtained for all subjects. Further, measurements on the lesion included either an RCM examination or a traditional cutting biopsy, depending on body location, insurance coverage, or patient preference. At each stage, the clinician provided her confidence level in her diagnosis. A total of 131 lesions clinically suspicious for BCC were imaged with LC-OCT in 104 patients. LC-OCT successfully imaged all 131 lesions, including those in challenging anatomical regions inaccessible to RCM, such as the nose. Tissue-coupled RCM was performed on 63 lesions, for which LC-OCT achieved 95.9% sensitivity, 85.7% specificity, and 93.7% accuracy (PPV 95.9%, NPV 85.7%). This analysis revealed four disagreements: two FN and two FP. The remaining 68 lesions, diagnosed with histology, showed 86.4% sensitivity, 79.2% specificity, and 83.8% accuracy (PPV 88.4%, NPV 76.0%). This analysis revealed 11 disagreements, 6 FN, and 5 FP. Using RCM or histology when available as the gold standard, LC-OCT had an overall sensitivity of 91.2%, specificity of 77.50%, and accuracy of 86.92%. For the 63 lesions evaluated with both LC-OCT and RCM, the agreement rate was 93.6% (Cohen's Kappa 0.81), with only 4 diagnostic discrepancies (2 FN and 2 FP). High-confidence LC-OCT diagnoses (≥ 8/10) achieved 100% sensitivity. Our findings demonstrate that LC-OCT provides high sensitivity, specificity, accuracy, PPV, and NPV when tested against both tissue-coupled RCM and histopathology. LC-OCT was easy to use in challenging facial regions where the RCM device can be difficult to operate. This high diagnostic accuracy suggests that LC-OCT may reduce the need for immediate biopsy, streamline clinical decision-making, and minimize scarring, thereby improving cosmetic outcomes. Although the widespread adoption of LC-OCT in the United States remains limited by current reimbursement barriers, this technology has the potential to become an essential tool in modern dermatologic oncology.

Long-term Local Control and Cosmesis of Electronic Skin Surface Brachytherapy for Basal Cell Carcinoma: A Prospective Multicenter Study.

The standard technique used for full-thickness reconstruction of the lower eyelid is the Hughes tarsoconjunctival flap. Despite its widespread use, objective postoperative assessments of eyelid morphology and tension remain rare. This cross-sectional clinical study included patients who underwent the Hughes procedure at the Department of Ophthalmology, University of Cologne. Eyelid morphology was evaluated using the VECTRA M3 stereophotogrammetry system in neutral position, manual downward traction, and standardized hook distraction with a 15.9g eyelid hook. Seventeen anatomical landmarks were identified per eye, measuring eight linear distances, two angles, and eyelid area. Operated and non-operated eyes were compared. Sixteen patients were included; 75% had basal cell carcinoma. In neutral position, operated eyes showed significantly larger lateral lid distances (p = 0.004), upper lateral lid distances (p = 0.008), and lateral canthal angles (p = 0.010). Under manual distraction, the lateral canthal angle remained larger (p = 0.003), while lateral lid mobility was reduced (p = 0.039). Hook distraction revealed smaller length and area changes in operated eyes (p ≤ 0.023, respectively), indicating increased tension. Subgroup analysis showed these differences were more pronounced in patients with defects >50% of eyelid length. In small defects, differences persisted but were less marked. The Hughes procedure increases lower eyelid tension and reduces tissue compliance, particularly in the temporal region and in large defects. Standardized tension testing, such as weighted hook distraction, may improve postoperative assessment and guide surgical refinements. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Multidisciplinary care pathways may improve quality of care, yet little is known about patients' perspectives regarding multidisciplinary treatment for high-risk head and neck cutaneous squamous cell carcinoma. This study examined health-related quality of life, decisional conflict, and satisfaction with care in 78 high-risk head and neck cutaneous squamous cell carcinoma patients undergoing multidisciplinary care. Pre-treatment, patients completed a baseline questionnaire, the EuroQoL-5D-5L, and the Decisional Conflict Scale. One month post-treatment, they completed the EuroQoL-5D-5L, Basal and Squamous Cell Carcinoma Quality of Life, and EORTC IN-PATSAT32 satisfaction questionnaires. Mean generic health-related quality of life scores were 0.76 pre-treatment and 0.81 post-treatment (p = 0.077), with minimal impact on disease-specific health-related quality of life (mean Basal and Squamous Cell Carcinoma Quality of Life scores ranging from 0.46 to 1.05). However, 73.7% of patients expressed worries about prognosis, and 12% of patients reported concerns regarding diagnosis and treatment substantially affecting health-related quality of life. The mean Decisional Conflict Scale total score was 26.61, with 19.2% of patients exceeding the clinically relevant threshold of 37.5, indicating decision delay or uncertainty regarding implementation. Approximately one-third of patients reported a need for better decision-making support. Overall, patients reported high satisfaction with care. In conclusion, while multidisciplinary care had minimal impact on health-related quality of life and resulted in high patient satisfaction, one-third of patients required more comprehensive information and value clarification.

Telepathology enables remote diagnostic consultation through digital image transmission and is particularly valuable in settings where subspecialty expertise is not immediately available. This study evaluated the diagnostic accuracy of PathoZoom®, a web-based platform that allows real-time remote review of microscope images via mobile devices during intraoperative frozen section examination in a high-complexity academic hospital. Seventy-five consecutive frozen section cases, processed between January and April 2024 at the University Hospital Trust of Modena/UNIMORE, were included. All cases were first diagnosed using conventional light microscopy (LM) and then, after a washout period, the same slides were reviewed remotely using the PathoZoom® system and mobile smartphones. Diagnostic concordance between LM and telepathology was assessed, classifying discrepancies as major or minor, depending on their clinical impact in accordance with the current guidelines of the College of American Pathologists guidelines. Overall concordance was 96% (72/75 cases). One major discordance occurred in a basal cell carcinoma margin assessment, interpreted as negative by telepathology and positive by LM. Two minor discrepancies involved polymorphonuclear cell counts in orthopedic specimens. No differences in performance were observed between mobile devices. Thanks to the technological setting and results, PathoZoom® and Smartphones are proposed as a diagnostic option for intraoperative consultation. Results support safety, feasibility and cost effectiveness of mobile-based telepathology in complex surgical settings and geographically extended healthcare networks.

Detection of keratin 20+ intratumoral Merkel cells can help differentiate benign cutaneous follicular tumors from malignant histopathologic mimics, though interpretive challenges highlight the need for additional diagnostic markers. POU4F3, a sensitive and specific nuclear marker for neoplastic Merkel cells, has yet to be thoroughly investigated as a marker for non-neoplastic Merkel cells within follicular neoplasms. We compared the performance of POU4F3 and keratin 20 in the detection of intratumoral Merkel cells. POU4F3 and keratin 20 immunostains were performed on 78 cases representing benign follicular tumors (trichoblastoma/trichoepithelioma, desmoplastic trichoepithelioma, trichofolliculoma, and basaloid follicular hamartoma), tumors with unclear pathogenesis (fibroepithelioma of Pinkus and cutaneous lymphadenoma), and malignant mimics (microcystic adnexal carcinoma and basal cell carcinoma). POU4F3+ intratumoral Merkel cells were detected in all cases of trichofolliculoma, basaloid follicular hamartoma, and fibroepithelioma of Pinkus, and in most cases of trichoblastoma/trichoepithelioma (94%), desmoplastic trichoepithelioma (91%), and cutaneous lymphadenoma (60%). POU4F3+ intratumoral Merkel cells were observed in 22% of microcystic adnexal carcinomas and absent in all basal cell carcinomas. Concordance between POU4F3 and keratin 20 expression was observed in 95% of cases. These findings support POU4F3's diagnostic value in distinguishing benign follicular tumors from malignant histopathologic mimics.

Diagnostic accuracy of two-photon fluorescence microscopy in Mohs surgery of basal cell carcinomas.

ObjectiveEosinophilic granulomatosis with polyangiitis (EGPA) was a rare systemic vasculitis characterized by eosinophilia, asthma, and necrotizing vasculitis. Metabolic dysregulation had been shown to participate in the pathogenesis of autoimmune diseases, but the plasma metabolic profile of EGPA remained unclear. This work was designed to systematically characterize the plasma metabolomic profiles of EGPA patients, identify differential metabolites that distinguish EGPA from bronchial asthma (BA), and explore their potential as biomarkers for differential diagnosis.MethodsTen patients with EGPA, ten patients with BA, and ten age- and gender-matched healthy controls (HCs) were enrolled. Untargeted metabolomics based on liquid chromatography/mass spectrometry (LC/MS) was performed to analyze the metabolic profiles of the three groups. Differential metabolites were identified using VIP > 1 and P < 0.05. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed on the differential metabolites, with statistical significance defined as P < 0.05.ResultsA total of 971 metabolites were differentially expressed between EGPA patients and HCs. KEGG pathway enrichment analysis identified 59 pathways, five of which were statistically significant (P < 0.05): caffeine metabolism; valine, leucine and isoleucine biosynthesis; alanine, aspartate and glutamate metabolism; arginine and proline metabolism; and glyoxylate and dicarboxylate metabolism. Comparison of EGPA with BA patients revealed 161 altered metabolites and 102 enriched pathways, three of which were significant (P < 0.05): caffeine metabolism, basal cell carcinoma, and Fc gamma R-mediated phagocytosis. Receiver operating characteristic (ROC) curve analysis demonstrated that 21 of the 24 metabolites identified from the five key EGPA-HC pathways exhibited strong diagnostic performance (area under the curve [AUC] > 0.8). Four metabolites (cholesterol, 5-acetylamino-6-formylamino-3-methyluracil, 5-acetylamino-6-amino-3-methyluracil, and 3-methylxanthine) showed high diagnostic potential (AUC > 0.8) for distinguishing EGPA from BA.ConclusionThis study revealed, for the first time, a distinct plasma metabolic profile in EGPA patients, with key pathways and candidate biomarkers identified. The metabolites with high diagnostic efficacy (AUC > 0.8) might serve as candidate diagnostic biomarkers for EGPA and its differentiation from BA. These observations provided novel insights into the metabolic basis of EGPA pathogenesis and might provide valuable references for the clinical management of this rare disease.

Advanced basal cell carcinoma (aBCC) is an uncommon but severe presentation of basal cell carcinoma, including those with extensive local invasion and metastasis. Curative local treatments are often not feasible for patients with aBCC and the introduction of Hedgehog pathway inhibitors (HHIs) expanded the therapeutic landscape. First-line therapy with the HHIs, vismodegib and sonidegib, provides effective disease control, and may enable the preservation of function in locally complex cases. Also, it offers the possibility to simultaneously treat multiple tumors, such as in patients with basal cell nevus syndrome. However, long-term HHI therapy is limited by toxicity, heterogeneous responses and the emergence of resistance or tolerance. For selected patients with progression or limited tolerability under HHIs, immune checkpoint inhibition has emerged as an established second-line option, offering durable responses in a subset of patients. However, immune-related adverse events remain a concern. To address the shortcomings of systemic therapy and improve the long-term disease control of patients with aBCC, ongoing research focuses on alternative dosing strategies, integration of combination or novel systemic agents and the development of predictive biomarkers. This review provides a comprehensive, clinically oriented overview of the evidence on systemic treatment for aBCC, emphasizing efficacy, safety, resistance mechanisms, and therapeutic strategies.

Background: Basal cell carcinoma (BCC) is the most common skin malignancy globally. Histopathological subtype influences prognosis and treatment selection, yet prospective data from Nepal remain limited. Objectives: To determine BCC subtype distribution, describe associations between morphology and pathological parameters, and identify high-risk features relevant to treatment planning at a Western Nepal referral center. Materials and Methods: We prospectively studied 35 consecutive histopathologically confirmed BCC cases at a tertiary care hospital in Western Nepal from September 1st, 2023, to August 31st 2025. Two observers independently reviewed hematoxylin and eosin-stained slides, evaluating subtype distribution, demographics, anatomical site, tumor depth, surgical margin status, perineural invasion, and ulceration. Results: Nodular BCC predominated (68.6%, n=24), with pigmented nodular variant most frequent (45.7% of all cases, n=16). Male to female ratio was 1.7 to 1; mean age 64.3±9.2 years. All cases were from head and neck sites, cheek/periocular region most common (57.1%, n=20), followed by nose/ear (31.4%, n=11). High-risk subtypes (n=7, 20%) showed higher biopsy margin involvement (71.4% vs 14.3%), greater mean invasion depth (2.8±1.1 mm vs 1.4±0.6 mm), and increased ulceration (57.1% vs 17.9%) compared to low-risk subtypes. Conclusion: Pigmented nodular BCC is the predominant subtype in Western Nepal. High-risk histopathological patterns suggested increased adverse features, including higher biopsy margin involvement. These findings are consistent with previously reported associations between high-risk histological patterns and adverse pathological features; however, validation with clinical outcome data is required.

Skin lesions are one of the most prevalent form of diseases existing among us. Early detection and classification of potentially malignant skin lesions can give us a lead in the fight against skin cancer. There are many lesion classification divisions on medical grounds; however, an automated system that detects and classifies a majority of these classes is not prevalent. In view of this scenario, our proposed study aims to classify the input skin lesion images into nine classes, namely, squamous cell carcinoma (SCC), Basal cell carcinoma (BCC), melanocytic nevi (NV), actinic keratoses and intraepithelial carcinoma (AKIEC), melanoma (MEL), seborrheic keratosis (SEK), dermatofibroma (DF), benign keratosis like lesions (BKL), and vascular lesions (VASC). The proposed methodology uses contrast stretching as an image enhancement technique to facilitate efficient Region of Interest (ROI) segmentation. The novelty of the proposed study lies in the first-hand implementation of Vision Transformer (ViT) for feature extraction in the domain of skin lesion detection. Finally, a light-weight multi-layer perceptron (MLP) composed of fully connected layers is used for multinomial classification. Combining the aforementioned techniques, the proposed method achieves training accuracy of 98% and testing accuracy of about 93.22%. The impressive performance across nine distinct categories represents a significant milestone. This success demonstrates the model’s scalability, suggesting it can be effectively extended to a broader array of diagnostic classes in future research.

Basal cell carcinoma is the most common malignant neoplasm in humans and represents a relevant clinical burden due to its high incidence, association with ultraviolet radiation, potential for local invasion, and frequent diagnostic delay in early or atypical presentations. This narrative literature review aimed to provide a practical framework for early recognition, differential diagnosis, risk stratification, and treatment selection in basal cell carcinoma. Evidence was synthesized from relevant publications indexed in PubMed, SciELO, and the Cochrane Library, prioritizing clinical guidelines, systematic reviews, randomized trials, and dermatologic oncology studies addressing diagnosis, dermoscopy, histopathology, surgical management, and nonsurgical therapies. The findings indicate that persistent pearly papules, telangiectatic nodules, superficial erythematous plaques, recurrent erosions, pigmented lesions, and scar-like indurated plaques should raise clinical suspicion. Dermoscopy improves diagnostic accuracy by identifying arborizing telangiectasias, blue-gray ovoid nests, leaf-like areas, spoke-wheel structures, ulceration, shiny white structures, and short fine telangiectasias. Treatment selection should be guided by tumor location, size, borders, recurrence, immune status, perineural involvement, and histological subtype. Low-risk tumors may be managed with standard excision or selected nonsurgical therapies, whereas high-risk lesions require complete margin assessment, preferably Mohs micrographic surgery. Early diagnosis and individualized treatment are essential to reduce recurrence, functional impairment, aesthetic morbidity, and healthcare costs.

Variations exist regarding evaluation of complete circumferential and deep margin assessment between Mohs surgeon's practices including section spacing, physical placement of the first section on the slide, and acceptable tumor-free margins. The impact of early incomplete sections (EIS) on margin interpretation has not been systematically studied. Here, we evaluate how inclusion of EIS affects tumor status interpretation during Mohs Micrographic Surgery. We retrospectively analyzed 500 basal cell carcinoma (BCC) Mohs pieces with EIS and prospective evaluation of 250 serially step-sectioned BCC pieces. In the retrospective cohort, inclusion of EIS reduced interpreted positivity from 47.2% to 41.2% reclassifying 12.7% of initially positive pieces as negative. Prospectively, EIS reduced positivity from 35.6 to 27.2%. Incorporation of EIS may reduce false-positive margin interpretations in Mohs Micrographic Surgery and potentially decrease unnecessary additional stages, depending on surgeon margin thresholds and cutting depth. The clinical application is nuanced and should take into account patient and tumor factors as determined by the Mohs surgeon.

Reconstruction after facial skin cancer excision requires balancing oncologic safety with cosmetic outcomes. Secondary intention healing (SIH) is a simple and cost-effective wound management approach that avoids complex reconstruction and permits close oncologic surveillance; however, it remains underutilized because of concerns regarding prolonged healing and unpredictable cosmetic results. Moreover, whether evidence derived primarily from Western populations can be extrapolated to Asian patients remains unclear. In this retrospective study, we reviewed 129 Japanese patients who underwent facial skin cancer excision, including 103 basal cell carcinomas and 26 squamous cell carcinomas. Among them, 87 patients were treated with SIH and 42 with surgical closure (SC). Cosmetic outcomes were evaluated in 48 patients by 10 independent evaluators using standardized postoperative photographs obtained approximately 1 year after surgery and assessed with a three-point scale ('noticeable', 'noticeable on close inspection', and 'not noticeable'). In the SIH group, the mean time to epithelialization was 39.51 ± 16.42 days, and defect size showed a significant positive correlation with epithelialization time. The median cosmetic score was 6.5 in the SIH group and 7.5 in the SC group, with no significant difference between groups (p = 0.755). Receiver operating characteristic curve analysis demonstrated that defects ≤ 14 mm in size were associated with a higher likelihood of favorable cosmetic outcomes. In univariate analysis, smaller defect size and concave surfaces of NEET (nose, eye, ear, and temple) location were associated with favorable cosmetic outcomes, whereas multivariate analysis identified defect size and female sex as independent predictors of unfavorable outcomes. These findings suggest that SIH is a cosmetically acceptable and clinically feasible reconstructive option after facial skin cancer excision in Japanese patients, in carefully selected cases with respect to sex, defect size and tumor location.

Efficacy and safety of sonidegib combined with photodynamic therapy in basal cell carcinoma: A retrospective case series of 7 patients.

Surgical scars of the nasal region following basal cell carcinoma (BCC) excision often present aesthetic and functional challenges, particularly the "trap-door" deformity related to flap reconstruction. Fractional CO₂ laser represents a promising therapeutic option to improve scar quality through collagen remodeling and dermal reorganization. This retrospective study analysed eight patients (six males and two females, mean age 71 ± 10 years) with nasal post-surgical scars after BCC excision and flap reconstruction. All patients underwent two sessions of fractional CO₂ laser in Deep Pulse or High Pulse modes, with a two-month interval between treatments. Clinical outcomes were evaluated using the Patient and Observer Scar Assessment Scale (POSAS) and three-dimensional profilometry with the Antera 3D system before treatment and two months after the last session. A statistically significant improvement was observed in both patient-reported (overall opinion p = 0.0007; thickness p = 0.03) and observer-reported parameters (vascularity p = 0.007; thickness p = 0.005; pliability p = 0.02; overall opinion p = 0.00004). Antera 3D analysis showed a mean reduction in scar depression of 23.5% (p = 0.01). All patients developed transient erythema and edema that were resolved within a week. Fractional CO₂ laser proved to be a safe and effective method to improve nasal post-surgical scars, enhancing texture, vascularity, and contour.

Combined Mohs micrographic surgery and 5-aminolevulinic acid photodynamic therapy for nasal ala basal cell carcinoma: A case report.