From the Journals

Reflectance confocal microscopy offers one-stop solution for BCC


 

FROM THE BRITISH JOURNAL OF DERMATOLOGY

For selected patients with basal cell carcinoma, one-stop shopping – diagnosing, subtyping, and excising the lesion all in one visit – using reflectance confocal microscopy was found noninferior to the standard approach of obtaining a punch biopsy to diagnose and subtype the lesion in one visit and performing surgical excision in a separate visit.

In addition to reducing the number of visits and the total time required for treatment, this new approach uses noninvasive reflectance confocal microscopy in the place of punch biopsy, which patients will likely prefer, said Daniel J. Kadouch, MD, of the department of dermatology, Academic Medical Center, Amsterdam, and his associates (British J Derm. 2017 Apr 9. doi: 10.1111/bjd.15559).

The study excluded patients who had lesions in a high-risk location of the face, lesions larger than 20 mm, recurrent lesions, and macroscopic ulcerating lesions, as well as patients who had basal cell nevus syndrome. Another 22 patients who were found to have non-BCC lesions (1 melanoma, 2 squamous cell carcinomas, 5 cases of Bowen’s disease, and 11 nonmalignant lesions) also were excluded, leaving 40 patients with BCC in the one-stop shopping group and 33 in the standard of care (control) group.

The primary outcome – the proportion of patients with tumor-free margins on the final pathology report after surgical excision – was 100% (40 of 40) in the one-stop shopping group and 94% (31 of 33) in the control group, which demonstrates the noninferiority of the new, less invasive approach, Dr. Kadouch and his associates said.

The mean total treatment time was 2 hours and 23 minutes for the one-stop shopping group. The total treatment time could not be determined for the control group because their surgical times weren’t recorded.

Adverse events included four postoperative wound infections in the one-stop shopping group, all of which were successfully treated with oral antibiotics, and one case of excessive postoperative bleeding in the control group, which required 3 days of hospitalization.

This study was limited in that it excluded patients with large lesions and those with BCC on high-risk areas of the face, which reduces the generalizability of the findings. In addition, a follow-up time of at least 1 year would be needed to detect signs of BCC recurrence in the study participants, the investigators said.

Recommended Reading

Organ transplant recipients face increased risk of BCC
MDedge Hematology and Oncology
Itraconazole targets basal cell carcinoma
MDedge Hematology and Oncology
Matrilin-2 protein distinguished BCCs from benign tumors in study
MDedge Hematology and Oncology
Study finds 19% of Merkel cell carcinomas are virus negative
MDedge Hematology and Oncology
Azathioprine linked to increased risk of SCC in transplant recipients
MDedge Hematology and Oncology
Skin cancer a concern in pediatric solid organ transplant recipients
MDedge Hematology and Oncology
Immune-suppressing drugs in IBD linked to higher skin cancer rates
MDedge Hematology and Oncology
Racial differences in skin cancer risk after organ transplantation
MDedge Hematology and Oncology
FDA approves first treatment for metastatic Merkel cell carcinoma
MDedge Hematology and Oncology
Avelumab produces durable responses in Merkel cell carcinoma
MDedge Hematology and Oncology