传统上,基底细胞癌(BCC)的“侵袭性”组织学亚型(HSs)更有可能在数量上表现出亚临床扩展(SCE),在Mohs显微手术(MMS)期间需要更多的阶段,因此,切除后边缘较大。然而,SCE的趋势从未与BCC的HSs进行前瞻性比较。
前瞻性地将BCC的HS与由清除肿瘤所需的MMS分期数定义的SCE的可能性相关联。
在未来,涉及17名Mohs外科医生在美国16种不同实践的多中心研究,收集了1686例接受MMS的BCC患者的数据.患者人口统计学,肿瘤特征,肿瘤清除所需的MMS分期数,并记录在索引活检和最终MMS阶段上记录的特定BCC亚型。
对清除肿瘤所需的每个HS的平均MMS分期数的分析揭示了2个不同的SCE程度(P<.0001):SCE的高(高于平均水平)风险(1.9个分期,1.0SD)和低(低于平均值)SCE风险(1.6阶段,0.9标准差)。高类别内的BCC亚型为morpheapform(2.1),渗透(1.9),元非典型(1.9),混合(1.8),和表面(1.8)。低类别包括基底鳞状细胞癌亚型(1.6),微结节(1.6),结节(1.6),和未指定(1.5)。从索引活检到最终MMS阶段,有324例(22.0%)表现出HS漂移或亚型变化。浅表BCC是唯一显示从索引活检到最终MMS阶段患病率增加的亚型(从16.0%到25.8%;P<.0002)。
索引活检的HSs可能不代表所有存在的HSs,导致抽样偏差。
表面BCC的SCE与BCC亚型的SCE一样可能被认为是“侵略性”,并且根据适当的使用标准被认为“适合”用于MMS。我们的研究还发现,当HS漂移发生时,亚临床上最可能延伸的亚型是浅表性BCC.
Traditionally \"aggressive\" histologic subtypes (HSs) of basal cell carcinoma (BCC) are more likely to quantitatively exhibit subclinical extension (SCE), requiring more stages during Mohs micrographic surgery (MMS) and, therefore, larger margins upon excision. However, the tendency for SCE has never been compared between HSs of BCC in a prospective manner.
To prospectively correlate the HS of BCC with the likelihood of SCE as defined by the number of MMS stages required to clear the tumor.
In a prospective, multicenter study involving 17 Mohs surgeons in 16 different practices across the United States, data regarding 1686 cases of BCC undergoing MMS were collected. Patient demographics, tumor characteristics, number of MMS stages required for tumor clearance, and specific BCC subtypes noted on both index biopsy and the final MMS stage were recorded.
Analysis of the average number of MMS stages for each HS required to clear tumor revealed 2 distinct degrees of SCE (P < .0001): high (higher than average) risk of SCE (1.9 stages, 1.0 SD) and low (lower than average) risk of SCE (1.6 stages, 0.9 SD). Subtypes of BCC within the high category were morpheaform (2.1), infiltrative (1.9), metatypical (1.9), mixed (1.8), and superficial (1.8). The low category included BCC subtypes of basosquamous (1.6), micronodular (1.6), nodular (1.6), and unspecified (1.5). Three hundred twenty-four cases (22.0%) manifested HS drift or a change in subtype from index biopsy to the final MMS stage. Superficial BCC was the only subtype that showed an increase in prevalence from index biopsy to the final MMS stage (from 16.0% to 25.8%; P < .0002).
HSs from index biopsy may not be representative of all HSs present, resulting in sampling bias.
SCE of superficial BCC was as likely as SCE of BCC subtypes that are considered \"aggressive\" and are deemed \"appropriate\" for MMS by the appropriate use criteria. Our study also found that when HS drift occurs, the most likely subtype to extend subclinically is superficial BCC.