Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clin
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REVIEW
Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clinical and histologic features Stephanie Clements1 · Amor Khachemoune2,3,4 Received: 2 June 2020 / Revised: 13 September 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The incidence of nonmelanoma skin cancer (NMSC) in the United States is increasing with approximately 3.6 million cases diagnosed per year. The staging and treatment of NMSC is guided by histologic subtype based on skin biopsy, along with other tumor-specific factors. However, a biopsy only represents a portion of the tumor, so there is a risk of upstaging at the time of definitive surgery. We conducted a review of the literature and found that a significant proportion of NMSC were upstaged during surgery. The rate of upstaging of basal cell carcinoma (BCC) was 7–31% and that of squamous cell carcinoma in situ (SCCIS) to squamous cell carcinoma (SCC) was 3–39%. Biopsy sampling error and variability in interpreting and reporting by dermatopathologists contribute to these discrepancies. It is pertinent to consider more comprehensive treatment modalities for tumors at high risk for upstaging. Diligence to identify tumors at higher risk for upstaging will allow clinicians to optimize management. Keywords Basal cell carcinoma · Squamous cell carcinoma · Upstaging · Mohs surgery · Nonmelanoma skin cancer Abbreviations NMSC Nonmelanoma skin cancer BCC Basal cell carcinoma SCC Squamous cell carcinoma SLNB Sentinel lymph-node biopsy NCCN National Comprehensive Cancer Center Network mm Millimeters MMS Mohs micrographic surgery WLE Wide local excision SCCIS Squamous cell carcinoma in situ BWH Brigham and Women’s Hospital cm Centimeters AJCC American Joint Committee on Cancer * Amor Khachemoune [email protected] 1
Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA
2
Veterans Affairs Medical Center, Brooklyn, NY, USA
3
Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
4
Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY 11209, USA
NOS Not otherwise specified MAC Microcystic adnexal carcinoma CD34 Cluster of differentiation 34 BSC Basosquamous carcinoma MCC Merkel cell carcinoma AK Actinic keratosis Tis Carcinoma in situ
Introduction The incidence of nonmelanoma skin cancer (NMSC) in the United States is increasing with approximately 3.6 million cases diagnosed per year [16, 22]. The proportion of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) was traditionally reported to be 4:1, respectively; however, recently, there has been a relative increase in the proportion of SCC cases [16]. The staging and treatment of NMSC is guided by histologic subtype based on skin biopsy, along with other tumor-specific factors. However, a biopsy only represents a portion of the tumor and may not inform the clinician of a tumor’s full histologic nature [11]. Thus, s
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