Comparación histopatológica entre biopsia preoperatoria y debulking luego de la cirugía micrográfica de Mohs en carcinomas cutáneos

Leticia Bermúdez; Romina Muguruza; Carlos Bazzano; Julio Magliano

doi:10.29193/RMU.38.1.7

Authors

Leticia Bermúdez Dermatóloga
Romina Muguruza Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Dermatología, Residente
Carlos Bazzano Universidad de la República, Facultad de Medicina, Cátedra de Dermatología, Prof. Titular
Julio Magliano Universidad de la República, Facultad de Medicina, Cátedra de Dermatología, Prof. Adjunto. Unidad de Cirugía Dermatológica, Jefe

DOI:

https://doi.org/10.29193/RMU.38.1.7

Keywords:

MOHS MICROGRAPHIC SURGERY, DEBULKING SURGERY, NON-MELANOMA SKIN CANCER, BIOPSY, COMPARATIVE STUDY, HISTOPATHOLOGICAL SUBTYPES

Abstract

Introduction: histological subtype is a vital element in determining the risk of skin cancer. It may be determined by an incisional biopsy which represents just a percentage of the tumor mass, the main concern lying in its potential failure to detect an agressive subtype. Therefore, comparing the results of biopsies with the surgically obtained piece with Mohs micrographic surgery is significantly relevant.
Objective: to compare histopathologic evaluation results of incisional biospy and debulking in skin cancer treated with Mohs micrographic surgery at the Dermatology Service of the Clinicas University Hospital, between November, 2013 and March, 2019.
Methodology: retrospective, descriptive study analysing 202 non-melanoma carcinomas which were treated with Mohs micrographic surgery the Dermatology Service of the “Dr. Manuel Quintela” Clinicas Hospital, between November, 2013 and March, 2019.
Results: the study only considered the cases where bulking identified the tumor. Biopsy matched debulking in 61.39% of cases. Debulking detected an agressive subtype that was not detected in the biopsy in 8.41% of the cases.
Conclusions: the hystopathological study of debulking has proved to be relevant, and the incisional biopsy was found to be partially representative in determining the histopathological subtype of non-melanoma carcinomas, since approximately 1 out of 10 carcinomas could be underdiagnosed and not appropriately treated.

References

1) Crowson AN. Basal cell carcinoma: biology, morphology and clinical implications. Modern Pathol 2006; 19(Suppl 2):S127-47. doi: 10.1038/modpathol.3800512.
2) Cameron MC, Lee E, Hibler B, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol 2019; 80(2):303-17. doi: 10.1016/j.jaad.2018.03.060.
3) Madan V, Lear JT, Szeimies RM. Non-melanoma skin cancer. Lancet 2010; 375(9715):673-85.
4) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Squamous cell skin cancer. NCCN, 2018, v.2.
5) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Basal Cell Skin Cancer. NCCN, 2018, v.1.
6) Roozeboom MH, Mosterd K, Winnepenninckx VJ, Nelemans PJ, Kelleners-Smeets NW. Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma. J Eur Acad Dermatol Venereol 2013; 27(7):894-8.
7) Izikson L, Seyler M, Zeitouni NC. Prevalence of underdiagnosed aggressive non-melanoma skin cancers treated with Mohs micrographic surgery: analysis of 513 cases. Dermatol Surg 2010; 36:1769-72.
8) Espinosa M, Poletti E, García C. Cirugía micrográfica de Mohs: experiencia de 1161 casos. Estudio retrospectivo, observacional y descriptivo. Dermatol Rev Mex 2013; 57(1):10-7.
9) Weisberg NK, Becker DS. Potential utility of adjunctive histopathologic evaluation of some tumors treated by Mohs micrographic surgery. Dermatol Surg 2000; 26(11):1052-6.
10) Cortés-Peralta EC, Ocampo-Candiani J, Vázquez-Martínez OT, Gutiérrez-Villarreal IM, Miranda-Maldonado I, Garza-Rodríguez V. Correlation between incisional biopsy histological subtype and a mohs surgery specimen for nonmelanoma skin cancer. Actas Dermosifiliogr (Engl Ed.) 2017; 109(1):47-51. doi: 10.1016/j.ad.2017.08.003.
11) Semkova K, Mallipeddi R, Robson A, Palamaras I. Mohs Micrographic surgery concordance between Mohs surgeons and dermatopathologists. Dermatol Surg 2013; 39(11):1648-52. doi: 10.1111/dsu.12320.
12) Bouzari N, Olbricht S. Histologic pitfalls in the Mohs technique. Dermatol Clin 2011; 29(2):261-72, ix.
13) Orengo IF, Salasche SJ, Fewkes J, Khan J, Thornby J, Rubin F. Correlation of histologic subtypes of primary basal cell carcinoma and number of Mohs stages required to achieve a tumor-free plane. J Am Acad Dermatol 1997; 37(3):395-7. doi: 10.1016/s0190-9622(97)70138-5.
14) Genders RE, Kuizinga MC, Teune TM, van der Kruijk M, van Rengen A. Does biopsy accurately assess basal cell carcinoma (BCC) subtype? J Am Acad Dermatol 2016; 74(4):758-60. doi: 10.1016/j.jaad.2015.10.025.
15) Wolberink EA, Pasch MC, Zeiler M, van Erp PE, Gerritsen MJP. High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases. J Eur Acad Dermatol Venereol 2013; 27:985-9.
16) Mosterd K, Thissen MR, van Marion AM, Nelemans PJ, Lohman BG, Steijlen PM, Kelleners-Smeets NW. Correlation between histologic findings on punch biopsy specimens and subsequent excision specimens in recurrent basal cell carcinoma. J Am Acad Dermatol 2011; 64(2):323-7. doi: 10.1016/j.jaad.2010.06.001.
17) Lee DA, Miller SJ. Nonmelanoma skin cancer. Facial Plast Surg Clin North Am 2009; 17(3):309-24.
18) Rapini RP. Epithelial Neoplasms. En: Rapini Ronald P. Practical Dermopathology. 2nd. ed. USA: Elsevier; 2012:253-75.
19) Messina J, Epstein EH Jr, Kossard S, McKenzie C, Patel RM, Patterson JW, et al. Basal cell carcinoma. En: Elder DE, Massi D, Scolyer RA, Willemze R, eds. WHO Clasification of Skin Tumours. 4th. ed. Lyon, France: ARC; 2018:26-34.
20) Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol 2015; 151(10):1081-6. doi: 10.1001/jamadermatol.2015.1187.
21) Murphy GF, Beer TW, Cerio R, Kao GF, Nagore E, Pulitzer MP. Squamous cell carcinoma. En: Elder DE, Massi D, Scolyer RA, Willemze R, eds. WHO Clasification of Skin Tumours. 4th ed. Lyon, France: ARC; 2018:35-45.
22) Welsch MJ, Troiani BM, Hale L, DelTondo J, Helm KF, Clarke LE. Basal cell carcinoma characteristics as predictors of depth of invasion. J Am Acad Dermatol 2012; 67:47-53.
23) Kamyab-Hesari K, Seirafi H, Naraghi ZS, Shahshahani MM, Rahbar Z, Damavandi MR, et al. Diagnostic accuracy of punch biopsy in subtyping basal cell carcinoma. J Eur Acad Dermatol Venereol 2014; 28:250-3.
24) Ebede TL, Lee EH, Dusza SW, Busam KJ, Nehal KS. Clinical value of paraffin sections in association with Mohs micrographic surgery for nonmelanoma skin cancers. Dermatol Surg 2012; 38:1631-8.
25) Swetter SM, Boldrick JC, Pierre P, Wong P, Egbert BM. Effects of biopsy-induced wound healing on residual basal cell and squamous cell carcinomas: rate of tumor regression in excisional specimens. J Cutan Pathol 2003; 30(2):139-46.
26) Stiegel E, Lam C, Schowalter M, Somani AK, Lucas J, Poblete-Lopez C. Correlation between original biopsy pathology and mohs intraoperative pathology. Dermatol Surg 2018; 44:193-7.
27) Haws AL, Rojano R, Tahan SR, Phung TL. Accuracy of biopsy sampling for subtyping basal cell carcinoma. J Am Acad Dermatol 2012; 66(1):106-11. doi: org/10.1016/j.jaad.2011.02.042.
28) Singh B, Dorelles A, Konnikov N, Nguyen BM. Detection of high-risk histologic features and tumor upstaging of nonmelanoma skin cancers on debulk analysis. Dermatol Surg 2017; 43(8):1003-11. doi: 10.1097/dss.0000000000001146.
29) Cohen PR, Schulze KE, Nelson BR. Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer. Dermatol Surg 2006; 32:542-51. doi: 10.1111/j.1524-4725.2006.32110.x.
30) Navarrete J, Gugelmeier N, Mazzei ME, González S, Barcia JJ, Magliano J. Lymph node metastasis with both components of combined cutaneous squamous cell carcinoma/Merkel cell (Neuroendocrine) carcinoma. Am J Dermatopathol 2017; 40(8):626-8.