Challenges for new adopters in pre-surgical margin assessment by handheld reflectance confocal microscope of basal cell carcinoma; a prospective single-center study

Nina Richarz; Aram Boada; Ane Jaka; Julio Bassas; Carlos Ferrandiz; Jose Manuel Carrascosa; Oriol Yélamos

doi:10.5826/dpc.1204a162

Challenges for new adopters in pre-surgical margin assessment by handheld reflectance confocal microscope of basal cell carcinoma; a prospective single-center study

Authors

Nina Richarz Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
Aram Boada Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
Ane Jaka Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelna, Spain
Julio Bassas Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelna, Spain
Carlos Ferrandiz Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
Jose Manuel Carrascosa Dermatology Department, University Hospital Germans Trial i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Institut d’investigació Germans Trias Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
Oriol Yélamos Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Dermatology Department, Centro Médico Teknon - Quirónsalud, Barcelona, Spain

Keywords:

reflectance confocal microscopy, basal cell carcinoma, micrographic Mohs surgery, margin control

Abstract

Introduction: In vivo reflectance confocal microscopy (RCM) is a useful tool for assessing pre-surgical skin tumor margins when performed by a skilled, experienced user. The technique, however, poses significant challenges to novice users, particularly when a handheld RCM (HRCM) device is used.

Objective: To evaluate the performance of an HRCM device operated by a novice user to delineate basal cell carcinoma (BCC) margins before Mohs micrographic surgery (MMS)

Methods: We performed a prospective study of 17 consecutive patients with a BCC in a high-risk facial area (the H zone) in whom tumor margins were assessed by HRCM and dermoscopy before MMS. Predicted surgical defect areas (cm²) were calculated using standardized photographic digital documentation and compared to final defect areas after staged excision.

Results: No significant differences were observed between median HRCM-predicted and observed surgical defect areas (2.95 cm² [range: 0.83–17.52] vs 2.52 cm² [range 0.71–14.42]; p=0.586). Dermoscopy, by contrast, produced significantly underestimated values (median area of 1.34 cm² [0.41-4.64] vs 2.52 cm² [range 0.71-14.42]; p<0.001). Confounders leading to poor agreement between predicted and observed areas were previous treatment (n=5), a purely infiltrative subtype (n=1), and abundant sebaceous hyperplasia (n=1).

Conclusion: Even in the hands of a novice user, HRCM is more accurate than dermoscopy for delineating lateral BCCs margins in high-risk areas and performs well at predicting final surgical defects.

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