Clinical factors predictive for histological aggressiveness of basal cell carcinoma: A prospective study of 2274 cases

Abstract

Introduction: Since surgery is the first-line treatment for basal cell carcinomas (BCC), the histological aggressiveness of the disease must be clinically predicted in order to apply optimal safety margins that ensure a high rate of complete resection while minimising the risk of recurrence.

Objectives: To evaluate clinical predictive factors of histological aggressiveness of BCC, we conducted a national prospective multi-centre study.

Methods: All consecutive patients presenting for BCC surgery were included, and standardised clinical data collected, and slides were submitted for review. Trabecular, micronodular and morpheaform BCCs were classified as aggressive.

Results: Of the 2710 cases included, 2274 were histologically confirmed. Clinical subtyping was correct in 49.9% of superficial BCCs, 86.2% of nodular BCCs and only 22% of aggressive BCCs. By multivariate analysis, aggressive BCCs were more frequently ulcerated (45%), indurated (70%), showed adherence (8.6%), and were associated with high-risk anatomical zones (50.3%, P<0.0001). These predictive clinical features may be helpful for decision making.

Keywords: Basal cell carcinoma; Dermatological surgery; Dermatopathology; Histological subtype; Skin cancer.