Simple 3-criteria-based ex vivo confocal diagnosis of basal cell carcinoma.
BACKGROUND
Fast and simple microscopic evaluation of basal cell carcinoma (BCC) together with its subtype determination would accelerate diagnostic and therapeutic procedures in dermatology including Mohs surgery.


OBJECTIVES
Assessing whether simplified 3-criteria-based ex vivo confocal microscopic (CM) examination can reliably predict BCC diagnosis and subtype. Analyzing interobserver agreement between expert and novice examiner.


METHODS
CM images of 235 skin samples from 150 patients were prospectively evaluated by 2 blinded examiners for the presence of 3 predefined BCC criteria namely presence of tumor mass, peripheral palisading and clefting.


RESULTS
Out of 235 skin samples 116 showed histological presence of BCC, confocally expert diagnosed a BCC in 110 and novice examiner in 107 samples. The overall sensitivity and specificity of detecting residual BCC was 96.6% and 98.7%, respectively. Confocally, examiners diagnosed correctly nodular BCC in 96.6%, respectively, 98.3%, superficial BCC in 96.8%, respectively, 93.5%, infiltrating BCC in 88.9%, respectively, 83.3% and other BCC subtype in 22.2%, respectively, 0% (expert and novice examiner, respectively).


CONCLUSION
Ex vivo CM allowed intraoperative examination of BCC based on only 3-criteria with high sensitivity and specificity, provided useful information on tumor subtype and showed that both experienced and non-experienced examiners may use this diagnostic approach with excellent results.
['Hartmann|Daniela|D|0000-0002-1002-8133', 'Krammer|Sebastian|S|', 'Bachmann|Mario R|MR|', 'Mathemeier|Leonie|L|', 'Ruzicka|Thomas|T|', 'von Braunmühl|Tanja|T|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002280:Carcinoma, Basal Cell D005260:Female D006801:Humans D008297:Male D018613:Microscopy, Confocal D008875:Middle Aged D015580:Mohs Surgery D012680:Sensitivity and Specificity D012878:Skin Neoplasms
Mohs surgery diagnostics in dermatology fluorescence confocal microscopy infiltrating basal cell carcinoma nodular basal cell carcinoma rapid pathology skin surgery skin tumors superficial basal cell carcinoma