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Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clinical and histologic features

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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.

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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

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

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Acknowledgements

The authors do not have any people, grants, or funds to acknowledge.

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The authors did not receive any funding for this work.

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Authors and Affiliations

  1. Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA

    Stephanie Clements

  2. Veterans Affairs Medical Center, Brooklyn, NY, USA

    Amor Khachemoune

  3. Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA

    Amor Khachemoune

  4. Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY, 11209, USA

    Amor Khachemoune

Authors
  1. Stephanie Clements
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Contributions

All authors made substantial contributions to the conception and design of the work. Stephanie Clements performed the literature search and data analysis for the work. The first draft of the manuscript was written by Stephanie Clements. All authors commented on the previous versions of the manuscript and revised them. All authors approved the final version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Amor Khachemoune.

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Clements, S., Khachemoune, A. Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clinical and histologic features. Arch Dermatol Res 313, 319–325 (2021). https://doi.org/10.1007/s00403-020-02151-5

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  • DOI: https://doi.org/10.1007/s00403-020-02151-5

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