A new approach for presurgical margin assessment by reflectance confocal microscopy of basal cell carcinoma.
BACKGROUND
Surgical excision represents the most common elective treatment for basal cell carcinoma (BCC). Several noninvasive approaches have been proposed for in vivo determination of tumour margin, in order to achieve radical removal.


OBJECTIVE
To propose a new approach through the combination of dermoscopy and reflectance confocal microscopy (RCM) for lateral margin detection in BCC.


METHODS
Ten patients with lesions clinically suggestive of nonpigmented BCCs with ill-defined margins were enrolled. All BCCs were dermoscopically evaluated first and the ill-defined margins were marked with a superficial cut and then inspected using RCM.


RESULTS
RCM evaluation showed BCC foci beyond the presurgical marker in three out of 10 lesions. Histology confirmed the RCM results: the presence of BCC features across the cut, corresponding to two superficial BCCs and a morpheaform BCC.


CONCLUSIONS
This new procedure helped to improve the identification of proper margins for surgical excision in nonpigmented BCC with clinically and dermoscopically ill-defined margins.
Department of Dermatology, University of Brescia, Brescia, Italy.
M
M
Venturini
Department of Dermatology, University of Brescia, Brescia, Italy.
G
G
Gualdi
Department of Dermatology, University of Brescia, Brescia, Italy.
A
A
Zanca
Department of Pathology, University of Brescia, Brescia, Italy.
L
L
Lorenzi
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
G
G
Pellacani
Department of Dermatology, University of Brescia, Brescia, Italy.
P G
PG
Calzavara-Pinton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D046169:Dermoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*