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Differences in BCC subtype reporting suggest gap in delivery of care

A lack of histologic subtyping in basal cell carcinoma may put patients at risk for inadequate or inappropriate therapy, according to researchers who explored the importance of subtyping in a retrospective study throughout various practice settings.

Shauna Higgins, MD, from the department of dermatology, University of Southern California, Los Angeles, and colleagues retrospectively studied 928 biopsy-proved basal call carcinomas treated with Mohs micrographic surgery by a single surgeon at an academic tertiary institution from 2015 to 2017.

BCCs lacked subtypes in 94 of the 928 (10.1%) biopsy pathology reports, according to the research letter published in JAMA Dermatology.

Subtype reporting was significantly associated with practice setting, but did not vary by race, ethnicity or insurance.

Histologic subtype was not provided in 36.2% of pathology reports from nonteaching institutions, 23.7% of reports from other teaching institutions and 6.2% of reports from academic institutions.

Forty-two of the 94 BCCs with no subtype (44.7%) were found to have aggressive subtypes during Mohs micrographic surgery; 22 cases were infiltrating, 21 cases were micronodular, four cases were morpheaform and two cases were basosquamous. Some cases had mixed histologic subtypes.

Significantly more Mohs layers were required for clearance among basal cell carcinomas without subtypes compared with BCCs labeled nonaggressive on initial biopsy results. This was in comparison to the mean number for BCCs reported as nonaggressive (mean 1.75; 95% CI, 0.08 to 0.48) but not those reported as aggressive according to biopsy (mean number of Mohs layers, 1.98; 95% CI, –0.32 to 0.21).

“Our study found significantly different pathology reporting patterns for BCC on biopsy results across practice settings, suggesting a potential gap in delivery of care,” the researchers wrote. – by Abigail Sutton

Disclosure: Co-author Wysong reported being an unpaid scientific advisor to Castle Biosciences on a squamous cell carcinoma research study unrelated to this paper.