Diagnostic Accuracy in Subtyping Basal Cell Carcinoma by Clinical Diagnosis Compared with Punch Biopsy.
(c) 2016 The Authors. doi: 10.2340/00015555 2448 Journal Compilation (c) 2016 Acta Dermato Venereologica. ISSN 0001 5555 Sir, We read with interest the recent article by Roozeboom et al. (1) reporting that a punch biopsy seems to be a better diagnostic tool than clinical diagnosis for the detection of histological basal cell carcinoma (BCC) subtypes. We wish to report our own results from a similar investigation and comment on the study design. To achieve an optimal therapeutic outcome it is important to identify those tumours most likely to respond to a chosen method (2) With the increasing use of topical therapies, which are unsuitable for the treatment of deep infiltrating and aggressive subtypes of BCC, studies aimed at evaluating the diagnostic performance of those methods most commonly used in daily practice to diagnose BCC are of great importance. BCC features can easily, and without discomfort to the patient, be assessed by clinical examination. By use of this method the entire tumour surface can be evaluated, but limited information about deeper tumour areas is obtained. Histological examination of a biopsy specimen is perceived to give a more accurate diagnosis of tumour subtype. A limitation of a diagnostic punch biopsy, however, is that it offers information from only a small, selected area of the whole tumour. The suggestion by Roozeboom et al. (1) that clinical diagnosis is inferior to punch biopsy in accurately subtyping BCC partly corroborates our own findings in a fairly similar designed investigation. This investigation emanates from an earlier described small, prospective study in which the primary aim was to investigate BCC thickness, but also included information about tumour subtype (3) The clinical diagnosis, punch biopsy and surgical excision of individual BCCs were obtained at a single visit. Through inspection and palpation, 2 consultants and an experienced registrar in dermatology first classified tumours clinically as either of superficial, nodular or aggressive subtypes, based on recognized clinical features (4) Then, a 3 mm biopsy punch was taken from the part of the tumour that was considered thickest in the clinical examination. Finally, a fusiform resection of the whole tumour was made. Biopsy Diagnostic Accuracy in Subtyping Basal Cell Carcinoma by Clinical Diagnosis Compared with Punch Biopsy
Acta dermato venereologica