RESUMO
BACKGROUND: Skin cancer specimen handling in Australian histopathology laboratories, while largely standardised, exhibits significant variations that affect clinical decision-making and patient outcomes. OBJECTIVE: This article provides clinicians with an understanding of histopathological processes to enhance diagnostic precision, inform surgical margin evaluations and refine management approaches. DISCUSSION: Understanding specimen handling and protocols is vital for accurate interpretation of pathology reports and management of skin cancers. Variations in sampling, examination and sectioning can affect pathological diagnosis and margin assessment. Clinician insights into laboratory processes are crucial for best practice. Retention of specimens and reports allows for further evaluation if clinical circumstances evolve or additional investigations are required.
Assuntos
Neoplasias Cutâneas , Manejo de Espécimes , Humanos , Neoplasias Cutâneas/diagnóstico , Austrália , Manejo de Espécimes/métodos , Laboratórios/normasRESUMO
BACKGROUND: Australia has the highest incidence of skin cancer globally. Early detection and treatment of skin cancer is critical for positive patient outcomes. General practitioners (GPs) play a central role in skin cancer management in Australia. OBJECTIVE: Collaboration between GPs and pathologists can improve the accuracy of skin cancer diagnosis. However, for improvement to occur, clear communication and high-quality specimens are essential. DISCUSSION: Inadequate clinical information and suboptimal biopsy specimens can hinder diagnosis. Improved communication, targeted training and selecting appropriate biopsy techniques are essential. A collaborative approach, guided by recommended techniques and clear guidelines, can minimise errors and improve patient outcomes in Australia's GP-led skin cancer management system.
Assuntos
Patologistas , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/terapia , Neoplasias Cutâneas/diagnóstico , Austrália , Biópsia/métodos , Clínicos GeraisRESUMO
BACKGROUND: A subset of melanocytic proliferations is difficult to classify by dermatopathology alone and their management is challenging. OBJECTIVE: To explore the value of correlation with dermatoscopy and to evaluate the utility of second opinions by additional pathologists. METHODS: For this single center retrospective study we collected 122 lesions that were diagnosed as atypical melanocytic proliferations, we reviewed dermatoscopy and asked two experienced pathologists to reassess the slides independently. RESULTS: For the binary decision of nevus versus melanoma the diagnostic consensus among external pathologists was only moderate (kappa 0.43; 95% CI 0.25-0.61). If ground truth were defined such that both pathologists had to agree on the diagnosis of melanoma, 13.1% of cases would have been diagnosed as melanoma. If one pathologist were sufficient to call it melanoma 29.5% of cases would have been diagnosed as melanoma. In either case, the presence of dermatoscopic white lines was associated with the diagnosis of melanoma. In lesions with peripheral dots and clods, melanoma was not jointly diagnosed by the two pathologists if the patient was younger than 45 years. CONCLUSIONS: A considerable number of atypical melanocytic proliferations may be diagnosed as melanoma if revised by other pathologists. The presence of white lines on dermatoscopy increases the likelihood of revision towards melanoma. Peripheral clods indicate growth but are not a melanoma clue if patients are younger than 45 years.
Assuntos
Melanoma , Nevo , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Estudos Retrospectivos , Melanoma/diagnóstico , Melanoma/patologia , Nevo/diagnóstico , Encaminhamento e Consulta , Diagnóstico DiferencialRESUMO
Dermatoscopic white circles, seen with both non-polarized and polarized dermatoscopy, are a known clue to actinic keratosis in a flat lesion and invasive squamous cell carcinoma in a raised lesion. We have not discovered a previous published example of this clue in a melanoma. We present a case report of a 70-year-old Australian male with a pigmented superficial spreading melanoma on the face, Breslow thickness 1 mm, with dermatoscopic white circles displayed with both polarized and non-polarized dermatoscopy, and with dermatopathological correlation.
Assuntos
Melanoma , Neoplasias Cutâneas , Masculino , Humanos , Idoso , Dermoscopia , Austrália , Neoplasias Cutâneas/patologia , Melanoma/diagnóstico por imagem , Melanoma/patologia , Melanoma Maligno CutâneoRESUMO
BACKGROUND AND OBJECTIVE: Pigmented intraepidermal carcinoma is characterized by dermatoscopic dots and structureless areas, including dots in linear arrangement and by coiled vessels. There are no studies describing the dermatoscopic features of pigmented intraepidermal carcinoma on the head and neck. We aim to characterize the clinical and dermatoscopic appearance of this entity. PATIENTS AND METHODS: We retrospectively analyzed 79 cases of pigmented intraepidermal carcinoma on the head and neck. RESULTS: Pigmented intraepidermal carcinoma on the head and neck was characterized dermatoscopically by multiple colors (98.7 %, n = 78), pigmented circles (48.1 %, n = 38), white circles (17.7 %, n = 14), angulated lines (41.8 %, n = 33) and structureless areas (86.1 %, n = 68). Dots in linear arrangement were present in 13.9 % (n = 11). Coiled vessels were present in 7.6 % (n = 6), the dominant vessel type being prominent serpentine vessels (29.2 %, n = 23), thicker and/or redder in color than surrounding vessels, most being in the angular arrangement of the dermal plexus (24.1 %, n = 19). CONCLUSIONS: Pigmented intraepidermal carcinoma on the head and neck differs from current published descriptions of pigmented intraepidermal carcinoma, reaching statistical significance with a lower incidence of coiled vessels and a higher incidence of pigmented circles, with evident similarities to pigmented actinic keratosis at that location.
Assuntos
Carcinoma in Situ , Carcinoma de Células Escamosas , Dermoscopia , Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Ceratose Actínica/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: Squamous cell carcinoma (SCC) may present with perineural invasion (PNI). OBJECTIVE: To investigate the characteristics of early invasive SCC with or without PNI. METHODS: Consecutive SCC excisions were prospectively reviewed from a single Australian community-based practice for 2016-2018. Tumor characteristics recorded were anatomic site, maximum microscopic tumor surface diameter, invasion depth, grade of differentiation, and diameter of nerves with PNI. RESULTS: In total, 1,772 cases were collected. No PNI cases were found on female patients. Seven of the total 10 PNI cases were on facial sites. Maximum average microscopic tumor surface diameters ranged from 10.1 mm (well differentiated) up to 11.0 mm (moderately differentiated). Maximum average invasion depths by differentiation ranged from 1.7 (well differentiated) up to 2.6 mm (poorly differentiated). The PNI cases were as follows: well differentiated (n = 0), moderately differentiated (n = 4), or poorly differentiated (n = 6). Minimum average histopathological margins for well, moderately, and poorly differentiated SCC, respectively, were 1.4, 1.1, and 1.3 mm. Minimum microscopic tumor surface diameters for PNI cases were 7 mm for moderately and 5 mm for poorly differentiated SCC. Minimum microscopic invasion depths for PNI cases were 2.2 mm for moderate and 0.9 mm for poor differentiation. CONCLUSIONS: We found early SCC with PNI displayed nerve diameters of 0.1 mm or less and were exclusively on male patients aged 60 or older, on chronically sun-exposed sites of the head and upper midline anterior chest. Histopathological features associated with PNI were moderate and poor differentiation, tumor invasion beyond 0.9 mm, and adjacent lymphocytosis.
RESUMO
BACKGROUND: Basal cell carcinoma (BCC) may present with or without perineural invasion (PNI). We reviewed BCC for PNI by subtype, microscopic tumor surface diameter, invasion depth, and anatomic site. METHOD: Consecutive excisions were prospectively collected in an Australian center 2016-2018. RESULTS: Total cases were 3005 including 40 with PNI: 28 in males, 12 in females. Superficial and nodular subtypes had no PNI. As the percentage tumor mass of infiltrative BCC increased beyond 90% the presence of PNI substantially escalated (OR7.0). Comparing PNI absent or present the respective maximum mean tumor microscopic surface diameters ranged from (95%CI [9.6-10.0] P < .001) to 11.2 mm (95%CI [9.4-13.0] P = .59). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98-1.05] P < .001) to 2.3 mm (95%CI [1.8-2.7] P < .001). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98-1.05] P < .001) to 2.3 mm (95%CI [1.8-2.7] P < .001) to 2.3 mm (95%CI[1.8-2.7] P < .001). Males recorded most PNI on the scalp, followed by cheek and chin. Patients with more than two BCC cases had a greater proportional PNI risk (OR3.7). Mean PNI nerve diameters were 0.06 mm2 (males) and 0.03 mm2 (females). CONCLUSION: Increases in percentage infiltrative subtype within the tumor mass, microscopic tumor diameter, tumor invasion depth, and BCC cases per patient all recorded more PNI. Minimum invasion depths with PNI were 1.0 mm on males (nose) and 1.0 mm females (forehead).
Assuntos
Carcinoma Basocelular/patologia , Nervos Periféricos/patologia , Neoplasias Cutâneas/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estudos ProspectivosRESUMO
BACKGROUND: Invasive squamous cell carcinoma (SCC) is typically treated by surgical excision. METHODS: Consecutive SCC excisions were reviewed prospectively in a single Australian center from 2009 to 2017. Cases were examined for recurrence by histopathologic margins, microscopic tumor surface diameter, invasion depth, grade of differentiation, and anatomic site. RESULTS: Over 9 years, 1296 cases were collected. By grade of differentiation maximum average microscopic surface diameters ranged from 8.0 to 9.6 mm and maximum average depths from 1.3 to 2.5 mm. Minimum average histopathologic margins for well, moderate, and poorly differentiated SCC, respectively, were 1.4, 1.1, and 1.3 mm. Recurrence occurred in 1.7% of well (n = 18/1084), 1.8% moderate (n = 3/165) and 6.4% in poorly differentiated (n = 3/47) SCC. No recurrence occurred beyond a histopathologic margin of 3.5 mm for well and 2.5 mm for moderately differentiated SCC. Highest recurrence for well-differentiated SCC by anatomic site was the lip (7.0%) then ear (4.6%). CONCLUSION: We found a recurrence rate of 1.0% for histopathologic margins of 1.5 mm with early well-differentiated SCC. The grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins. Poorly differentiated SCC and ear or lip sites require wider surgical margins.
Assuntos
Carcinoma de Células Escamosas , Recidiva Local de Neoplasia , Neoplasias Cutâneas , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: The depth of invasion by basal cell carcinoma (BCC) subtypes varies. OBJECTIVE: To investigate BCC invasion depth variation by subtype and anatomic site. METHOD: A prospective consecutive case series of excised BCC from 2009 to 2014 in a single Australian clinic. RESULTS: Descending mean depths for a total of 4,565 BCC cases by subtype were as follows: nodulocystic, 1.9 mm (n = 84, 95% CI: 1.70-2.03, P = 0.66); nodular, 1.6 mm (n = 947, 95% CI: 1.53-1.63, P < 0.0001); aggressive, 1.5 mm (n = 925, 95% CI: 1.44-1.59, P < 0.0001); superficial combined with nodular, 0.9 mm (n = 1,081, 95% CI: 0.83-0.90, P < 0.0001); and superficial, 0.3 mm (n = 1,528, 95% CI: 0.32-0.36, P < 0.0001). Deeper invasion was associated with increased chronic sunlight exposed sites. The deepest aggressive BCCs occurred on the neck with a mean depth of 1.8 mm (n = 46, 95% CI: 1.47-2.21). CONCLUSION: We found significant differences in the depth of invasion for BCCs by sex, subtype, and anatomic site. For BCC with characteristics matching this study, overall adequate microscopic excision depths are proposed: superficial, 1.0 mm; superficial combined with nodular, 2.0 mm; nodular, 3.0 mm; and aggressive, 3.0 mm.
RESUMO
BACKGROUND: Basal cell carcinoma (BCC) may present as superficial subtype alone (sBCC) or superficial combined with other subtypes. The objective of this study was to compare sBCC without or with other BCC subtypes by age, sex and anatomic site. METHODS: We retrospectively collected superficial BCC with the above characteristics from an Australian center during 2009 to 2014. RESULTS: We recorded 1528 sBCC and 1622 superficial BCC combined with other BCC subtype cases. Males numbered 2007 and females 1140. On males, head sites (forehead, cheek, nose and ear combined) compared to limb plus trunk sites displayed a higher incidence of superficial BCC combined with either nodular and or aggressive BCC subtypes (OR 13.15 CI 95% 8.9-19.5 P < .0001). On females a similar comparison also found a higher incidence of superficial BCC combined with solid subtype BCC on head sites compared to trunk and limb sites (OR 9.66 CI 95% 5.8-16.1 P < .0001). CONCLUSION: Superficial BCC alone is more likely on younger females on trunk and limb sites. Small partial biopsies reported as sBCC may miss other BCC subtypes present with higher risk on facial sites for males and females. Males had smaller proportions of superficial only subtype BCC on facial and ear sites compared to females.
Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Invasive squamous cell carcinoma (SCC) may present clinically with or without a horn. OBJECTIVE: To compare invasive SCC with or without horn presentation by anatomic site, tumor diameter, depth, and grade of differentiation. MATERIALS AND METHODS: The above characteristics of invasive SCC with or without horns were compared using a logistic regression model adjusted for potential confounders. RESULTS: There were 7.0% horns (n = 116) and 93.0% nonhorns (n = 1,550) in 1,666 cases. The median tumor diameter was 6 mm for horns, and 8 mm for nonhorn cases, p < .001. The median depth of invasion was 0.8 mm for horn cases and 1.3 mm for nonhorns, p < .001. Most cases were well-differentiated SCC for both horns (n = 102, 87.9%) and nonhorns (n = 1,265, 81.6%) p = .07. Horn cases had a borderline significant shift to well differentiation with moderate differentiation in 11.2% of cases (n = 13) and poor differentiation in 0.9% (n = 1). CONCLUSION: Horns presented on invasive SCC with reduced tumor diameters and reduced invasion depths compared to nonhorns. Horns presenting on invasive SCC were usually well differentiated. However, moderate and even poor differentiation can occur within a horn base.