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BCC of the ear linked with higher discordance between biopsy, Mohs histopathology

CHICAGO — Biopsy alone detects fewer aggressive subtypes of basal cell carcinoma of the ear compared with Mohs histopathology, according to data presented here at the American Society for Dermatologic Surgery annual meeting.

Due to a lack of research assessing histopathology concordance rates for biopsy and Mohs micrographic surgery in head and neck basal cell carcinomas (BCCs), Kira Minkis, MD, PhD, of Weill Cornell Medicine, and colleagues aimed to compare rates and clinical characteristics of BCCs of the ear and face.

All patients undergoing Mohs histopathology of the ear (n = 92) and other parts of the face (n = 40) between 2011 and 2016 at Weill Cornell Medicine were included in a retrospective chart review. Data included demographics, lesion clinical features, subtype on biopsy and Mohs histology, surgical management and follow-up information.

On original biopsy, lesions of the ear were 1.49 times more likely to be aggressive than non-ear lesions, but the difference was not statistically significant; this increased to 5.86 times more likely when looking at Mohs histopathology (P < .0001).

The agreement between biopsy and Mohs histopathology for BCCs of the ear was 53% (Kappa = .08); three-quarters of discordant cases (76%) were more aggressive by Mohs histopathology. However, the agreement was 83% for patients with BCC not on the ears (Kappa = .46), and 50% of discordant cases were more aggressive by Mohs histopathology. Agreement was higher among younger patients (74%; Kappa = .36) compared with those aged 65 years or older (58%; Kappa = .15).

“Within the treatment algorithm for BCC of the ear, treating clinicians need to bear in mind that superficial biopsies often obtained to establish diagnosis may not accurately detect all the different subtypes of BCC,” Minkis told Healio Dermatology. “This could have the potentially lead to undertreatment in that the less aggressive, low-risk subtypes could be treated by other means such as topical therapies or electrodessication and curettage, which may lead to missing a deeper component or subclinical extension that you may get with more aggressive subtypes. Ultimately, this can lead to higher morbidity and cost for treating recurrent tumors. Therefore, Mohs surgery should be undertaken whenever possible for BCCs of the ear to allow for full margin assessment and complete tumor extirpation.” – by Stacey L. Adams

Reference:

Minkis K, et al. High discordance rates between biopsy and Mohs histopathology for basal cell carcinomas of the ear. Presented at: American Society for Dermatologic Surgery annual meeting; Oct. 24-27, 2019; Chicago.

Disclosures: Minkis reports no relevant financial disclosures.