RESUMEN
BACKGROUND: Ex vivo confocal microscopy using fusion mode and digital staining (EVCM) scans unfixed fresh tissue and produces rapidly digitally stained images of very similar quality to classical pathology. We investigated whether EVCM could represent an alternative to the standard histological examination of the pretherapeutic basal cell carcinoma (BCC) punch biopsies. OBJECTIVES: The objective of the study was to assess diagnostic accuracy of EVCM versus traditional histopathological examination for diagnosing and subtyping clinically suspicious lesions of BCC in 3-mm fresh and nonfixed punch biopsies. METHODS: In this prospective monocentric observational study, patients with clinically suspected BCC were consecutively enrolled. Punch biopsies were imaged using EVCM and subsequently processed for standard histologic examination (gold standard). EVCM images were examined by a dermatopathologist blinded to clinical aspect of the lesion and histopathological results. Concordance between the EVCM and histology analysis was calculated with Cohen's kappa (κ) statistic. RESULTS: Sixty-six patients were recruited, and 106 biopsies were analyzed. EVCM correctly diagnosed 70/73 BCCs and 31/33 non-BCC lesions, corresponding to a sensitivity of 96% and a specificity of 94% (positive predictive value = 97%, negative predictive value = 91%). The EVCM assessment led to over-staging and under-staging of BCC subtypes in 5% and 11% of cases, respectively. It led to over-staging and under-staging of BCC depths in 5% and 15%, respectively. The kappa coefficient for concordance was 0.78 (95% confidence interval [CI]: 0.69-0.88) when considering BCC subtypes and 0.81 (95% CI: 0.72-0.90) when considering BCC depths. CONCLUSIONS: These results render EVCM as a promising option for "real-time" pretreatment evaluation of clinically suspected BCC lesions. Further larger randomized studies are needed to assess the efficiency of EVCM versus standard care in patients with clinically suspected BCC.
RESUMEN
AIMS: The goal of this work was to assess the validity of Mohs Micrographic Surgery (MMS) for basal cell carcinoma (BCC) in a routine clinical setting. MATERIAL AND METHODS: Our adaptation of the technique described by Mohs and coll allows intraoperative histological examination of all surgical edges of the resection. Sixteen men and 4 women were selected. RESULTS: Average operative time was 2 hours 30 minutes. No false results were noted. The cosmetetic and functional outcomes were good. CONCLUSION: MMS is a safe and reproducible surgical technique made possible by solid team work. It is adapted for the treatment of BCC with a high risk of recurrence. The cosmetetic and functional results are quite satisfactory. The recurrence rate at 5 years is 10 times less than with other methods of treatment. The additional time required for this surgery be put in balance with the number of tumors for which a second intervention would have been necessary if conventional surgery had been used. All procedures were performed under local anesthesia, and none or the patients required a second intervention.
