Preoperative evaluation of high-risk basal cell carcinoma with line-field confocal optical coherence tomography (LC-OCT) reduces Mohs micrographic surgery stage number: A case-control study

Mohs micrographic surgery (MMS) is the preferred surgical approach for high-risk basal cell carcinoma (BCC). Pre-surgical tumor margins delineation with line field confocal optical coherence tomography (LC-OCT) is expected to reduce MMS stages number. to investigate the effectiveness of LC-OCT preop...

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Published in:EJC skin cancer Vol. 2; p. 100015
Main Authors: Paradisi, Andrea, Cornacchia, Luigi, Cappilli, Simone, Abeni, Damiano, Federico, Francesco, Di Stefani, Alessandro, Mannino, Maria, Peris, Ketty
Format: Journal Article
Language:English
Published: Elsevier Ltd 01.12.2024
Elsevier
Subjects:
Diagnostic imaging
High-risk basal cell carcinoma
Line-field confocal optical coherence tomography
Mohs micrographic surgery
Surgical margins
Mohs micrographic surgery
Surgical margins
Diagnostic imaging
Line-field confocal optical coherence tomography
High-risk basal cell carcinoma
ISSN:2772-6118, 2772-6118
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Summary:Mohs micrographic surgery (MMS) is the preferred surgical approach for high-risk basal cell carcinoma (BCC). Pre-surgical tumor margins delineation with line field confocal optical coherence tomography (LC-OCT) is expected to reduce MMS stages number. to investigate the effectiveness of LC-OCT preoperative evaluation of high-risk BCC margins in reducing the number of MMS stages to achieve tumor clearance. high-risk BCC patients undergoing MMS at Policlinico A. Gemelli Foundation, IRCCS – Rome during January 2018 – December 2022. The LC-OCT group included patients undergoing preoperative lateral tumor margin demarcation by clinical, dermoscopic, and LC-OCT examination; patients in the control group underwent preoperative lateral tumor margin demarcation by clinical and dermoscopic examination only. LC-OCT imaging was compared to MMS histopathological sections. 63 facial high-risk BCCs from 60 patients, mean age of 68.3 years (SD 11.9). The LC-OCT and the control group included 22 and 41 BCCs, respectively. LC-OCT imaging showed almost perfect agreement with histopathology for low- versus high-risk of recurrence BCC histopathological subtypes discrimination (Cohen’s kappa 0.88). We reported a significant difference in the mean number of MMS stages between the LC-OCT and the control group (1.23 ± 0.43 SD, and 1.89 ± 1.05 SD, respectively; p-value =0.007). At univariate regression analysis, LC-OCT preoperative mapping of BCC tumor margins significantly reduced patients’ risk of undergoing >1 MMS stage (crude odds ratio [ORc]: 0.3 95% CI 0.1–0.8, p-value =0.032). LC-OCT preoperative evaluation of high-risk BCC margins significantly reduced the number of MMS stages to achieve tumor clearance. •LC-OCT preoperative evaluation of BCC margins reduces the number of Mohs stages.•LC-OCT imaging shows a strong agreement with BCC histopathological examination.•LC-OCT is useful also for aggressive BCC histopathological subtypes evaluation.
ISSN:2772-6118
2772-6118
DOI:10.1016/j.ejcskn.2023.100015