From the Guidelines
When dealing with a circumscribed lesion, particularly in the context of cutaneous malignant melanoma, the most critical step is to perform a full thickness excisional biopsy with a margin of 2 mm of normal skin around the lesion, as recommended by the ESMO clinical guidelines 1. This approach ensures that the lesion is completely removed and allows for accurate diagnosis and staging. The biopsy should be processed by an experienced pathology institute to confirm the diagnosis and guide further treatment. In the context of circumscribed lesions, it is essential to prioritize diagnostic accuracy to determine the appropriate treatment plan, which may include further surgery, adjuvant therapy, or follow-up care. Key considerations in managing circumscribed lesions include:
- Accurate diagnosis through full thickness excisional biopsy
- Margin of 2 mm of normal skin around the lesion
- Processing by an experienced pathology institute
- Adherence to ESMO clinical guidelines for diagnosis, treatment, and follow-up 1.
From the Research
Definition and Classification
- Basal cell carcinoma (BCC) is a type of skin cancer that can be classified into different subtypes, including nodular, superficial, pigmented, and infundibulocystic BCC with adnexal differentiation, as well as high-risk tumors such as micronodular, infiltrating, and sclerosing/morphoeic subtypes 2.
- The classification of BCC is important for determining the appropriate treatment approach, as some subtypes are more aggressive than others 2, 3.
Diagnosis and Biopsy
- Skin biopsy is essential for confirming the diagnosis of BCC and evaluating the risk of recurrence 4, 3.
- Different biopsy techniques can be used, including punch biopsy, shave biopsy, and excisional biopsy 5.
- The agreement between the histological subtype of BCC from punch biopsy and the findings of Mohs surgery can be low, highlighting the importance of using multiple diagnostic approaches 6.
Treatment Approaches
- Treatment options for BCC include surgical excision, Mohs micrographic surgery, cryosurgery, electrodesiccation and curettage, topical application of imiquimod or fluorouracil, photodynamic therapy, and radiation therapy 4, 3.
- Novel treatment approaches, such as hedgehog pathway inhibitors, have been investigated for the treatment of BCC, particularly for advanced or metastatic cases 2, 3.
- The choice of treatment approach depends on various factors, including the subtype and location of the tumor, as well as the patient's condition and preferences 4, 3.