WORK-UP/BIOPSY TECHNIQUES OF NON-MELANOMA SKIN CANCER (NMSC)

  • Work-up of any NMSC should include a thorough history, including:
    • Reported duration
    • Rate of growth
    • Associated symptoms
    • Previous treatment
    • Risk factors for NMSC
  • Changes noted by the patient may be quite subtle and include:
    • Itching
    • Tenderness
    • Bleeding
    • Changes in size, color, or texture
  • A detailed head-to-toe skin examination should be performed:
    • With careful inspection and palpation of suspicious lesions
  • In patients suspected of having SCC:
    • The draining lymph node basins should be evaluated for nodal metastases by palpation
  • In general, radiologic studies are not necessary for the evaluation of patients with SCC:
    • However, if high-risk features are present:
      • A magnetic resonance imaging study can be obtained to evaluate the extent of tumor involvement and ultrasound can be used for the evaluation of regional nodal basin(s)
  • Any cutaneous lesion suspicious for malignancy should be biopsied for pathologic assessment
  • Biopsy of suspicious pigmented lesions should be limited to:
    • Punch or excisional biopsy techniques:
      • In which the full thickness of the dermis can be evaluated
    • A punch biopsy:
      • Usually ranges in size from 2 to 8 mm
        • Involves removing a cylinder of tissue, ideally to the level of the subcutaneous fat
        • Often, entire lesions can be removed for pathologic examination:
          • If not, the most suspicious aspect of the tumor may be sampled
    • Shave biopsy:
      • Is an excellent technique for:
        • Superficial lesions
        • Nonpigmented lesions suspicious for BCC or SCC
      • It is also a good biopsy technique for cutaneous horns or keratoacanthomas provided the base of the tumor is included in the specimen
      • A shave biopsy involves injecting local anesthesia into the epidermis and upper dermis and then performing a tangential sample at the base of the wheal
      • A sterile flexible razor bladeor a 15 blade is recommended so that the mid-dermis is included in the biopsy specimen
      • If performed too superficially:
        • Invasion into the dermis cannot be evaluated and rebiopsy may be required
    • Excisional biopsy:
      • Involves removal of the entire lesion with a margin of clinically clear tissue:
        • It is generally used for classic lesions such as:
          • Superficial SCCs
          • Nodular BCCs
          • Superficial BCCs
      • Margins can be evaluated in the specimen, and further treatment is often unnecessary
  • A number of noninvasive diagnostic tools including:
    • Dermoscopy, high-frequency ultrasound, optical coherence tomography, and confocal microscopy:
      • Have been investigated for screening, diagnosis, and management of NMSC
      • The benefits of these modalities are that they allow the examination of large affected areas and monitoring and surveillance of selected skin sites for topical treatment modalities (e.g., patients with AK or BCC treated with imiquimod)

#Arrangoiz #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #CASO #CenterforAdvancedSurgicalOncology #SkinCancer #BCC #SCC #NonMelanomaSkinCancer

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