Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study Journal Article


Authors: Navarrete-Dechent, C.; Cordova, M.; Aleissa, S.; Liopyris, K.; Dusza, S. W.; Phillips, W.; Rossi, A. M.; Lee, E. H.; Marghoob, A. A.; Nehal, K. S.
Article Title: Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study
Abstract: Background: Biopsy specimens from patients with basal cell carcinoma (BCC) can present to surgery with no clinically residual tumor, complicating treatment decisions. Objective: To evaluate reflectance confocal microscopy (RCM) for the assessment of residual BCC following biopsy. Methods: Consecutive patients with biopsy-proven BCC and no clinical evidence of residual tumor who had been referred for Mohs micrographic surgery were included. Biopsy sites were imaged with a handheld RCM device. On the basis of RCM evaluation, cases were labeled RCM positive or RCM negative. Mohs micrographic surgery was performed in all cases; margins and 15-μm serial vertical sectioning were evaluated. Results: A total of 61 patients were included (mean age, 61.7 years [standard deviation, 12.2 years]; range, 37-87 years); 60.7% were women. The mean lesion size was 5.1 mm (range, 3-12 mm); 73.8% of patients were positive on RCM, and 68.9% had residual BCC on histopathologic examination. The rates of RCM sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 68.4%, 86.6%, and 81.2%, respectively. Three cases of BCC (high-risk, infiltrative, and basosquamous) were missed with use of RCM. When high-risk subtypes were excluded (n = 5), sensitivity and negative predictive value were both 100%. Limitations: RCM can miss deep-seated residual tumor. Conclusion: RCM is a valuable tool for the evaluation of residual BCC following biopsy, with the potential to reduce unnecessary surgical procedures. © 2019 American Academy of Dermatology, Inc.
Keywords: dermoscopy; reflectance confocal microscopy; basal cell carcinoma; biopsy; surgery; mohs micrographic surgery; residual
Journal Title: Journal of the American Academy of Dermatology
Volume: 81
Issue: 2
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2019-08-01
Start Page: 417
End Page: 426
Language: English
DOI: 10.1016/j.jaad.2019.02.049
PUBMED: 31227277
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 2 August 2019 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Kishwer S Nehal
    165 Nehal
  2. Stephen Dusza
    169 Dusza
  3. Ashfaq A Marghoob
    397 Marghoob
  4. Erica H Lee
    55 Lee
  5. Anthony Rossi
    98 Rossi
  6. Miguel A Cordova
    45 Cordova