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Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma : Analysis of 737 Cases

Hopkins, Katherine ; Ingvar, Åsa LU orcid ; Palmgren, Johan LU ; Thorhallsdottir, Valdis LU ; Nielsen, Kari LU orcid and Saleh, Karim LU (2025) In Acta Dermato-Venereologica 105.
Abstract

The recommended treatment for cutaneous squamous cell carcinoma is surgical excision. An initial punch biopsy is often performed as an aid to diagnosis. A retrospective registry-based study was performed to assess histopathological concordance of punch biopsy of cutaneous squamous cell carcinoma and subsequent excision. Analysis of 737 punch biopsies and subsequent matched excisions was performed. In total, 493 (67%) lesions were confirmed as invasive cutaneous squamous cell carcinoma on excision, 76% when excluding "scar" as a final diagnosis. Tumour diameter > 20mm was highly predictive of cutaneous squamous cell carcinoma (positive predictive value 91.1%). Tumours on the scalp were significantly more likely to demonstrate a final... (More)

The recommended treatment for cutaneous squamous cell carcinoma is surgical excision. An initial punch biopsy is often performed as an aid to diagnosis. A retrospective registry-based study was performed to assess histopathological concordance of punch biopsy of cutaneous squamous cell carcinoma and subsequent excision. Analysis of 737 punch biopsies and subsequent matched excisions was performed. In total, 493 (67%) lesions were confirmed as invasive cutaneous squamous cell carcinoma on excision, 76% when excluding "scar" as a final diagnosis. Tumour diameter > 20mm was highly predictive of cutaneous squamous cell carcinoma (positive predictive value 91.1%). Tumours on the scalp were significantly more likely to demonstrate a final diagnosis of cutaneous squamous cell carcinoma than those on the arm (odds ratio 6.11, 95% confidence interval 3.1,12.0). There was moderate concordance between biopsy and excision in grade of histopathological differentiation. This study demonstrates that clinical high-risk features may be of more value in predicting a diagnosis of cutaneous squamous cell carcinoma than partial punch biopsy. Use of clinical and dermoscopic competencies in assessment of cutaneous tumours rather than reliance on biopsies both avoids delay in patient management in the case of high-risk cutaneous squamous cell carcinoma and may also minimize unnecessary surgical excisions if there is a low clinical index of suspicion of cutaneous squamous cell carcinoma.

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; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Skin Neoplasms/pathology, Carcinoma, Squamous Cell/pathology, Retrospective Studies, Biopsy, Female, Male, Aged, Predictive Value of Tests, Middle Aged, Registries, Aged, 80 and over, Reproducibility of Results, Tumor Burden, Adult, Neoplasm Invasiveness
in
Acta Dermato-Venereologica
volume
105
article number
adv40727
publisher
Medical Journals Limited
external identifiers
  • pmid:39749387
  • scopus:85214589942
ISSN
1651-2057
DOI
10.2340/actadv.v105.40727
language
English
LU publication?
yes
id
d48bb11f-0481-4acf-b18b-b85f4ac90e08
date added to LUP
2025-02-05 11:04:56
date last changed
2025-02-06 04:01:33
@article{d48bb11f-0481-4acf-b18b-b85f4ac90e08,
  abstract     = {{<p>The recommended treatment for cutaneous squamous cell carcinoma is surgical excision. An initial punch biopsy is often performed as an aid to diagnosis. A retrospective registry-based study was performed to assess histopathological concordance of punch biopsy of cutaneous squamous cell carcinoma and subsequent excision. Analysis of 737 punch biopsies and subsequent matched excisions was performed. In total, 493 (67%) lesions were confirmed as invasive cutaneous squamous cell carcinoma on excision, 76% when excluding "scar" as a final diagnosis. Tumour diameter &gt; 20mm was highly predictive of cutaneous squamous cell carcinoma (positive predictive value 91.1%). Tumours on the scalp were significantly more likely to demonstrate a final diagnosis of cutaneous squamous cell carcinoma than those on the arm (odds ratio 6.11, 95% confidence interval 3.1,12.0). There was moderate concordance between biopsy and excision in grade of histopathological differentiation. This study demonstrates that clinical high-risk features may be of more value in predicting a diagnosis of cutaneous squamous cell carcinoma than partial punch biopsy. Use of clinical and dermoscopic competencies in assessment of cutaneous tumours rather than reliance on biopsies both avoids delay in patient management in the case of high-risk cutaneous squamous cell carcinoma and may also minimize unnecessary surgical excisions if there is a low clinical index of suspicion of cutaneous squamous cell carcinoma.</p>}},
  author       = {{Hopkins, Katherine and Ingvar, Åsa and Palmgren, Johan and Thorhallsdottir, Valdis and Nielsen, Kari and Saleh, Karim}},
  issn         = {{1651-2057}},
  keywords     = {{Humans; Skin Neoplasms/pathology; Carcinoma, Squamous Cell/pathology; Retrospective Studies; Biopsy; Female; Male; Aged; Predictive Value of Tests; Middle Aged; Registries; Aged, 80 and over; Reproducibility of Results; Tumor Burden; Adult; Neoplasm Invasiveness}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{Medical Journals Limited}},
  series       = {{Acta Dermato-Venereologica}},
  title        = {{Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma : Analysis of 737 Cases}},
  url          = {{http://dx.doi.org/10.2340/actadv.v105.40727}},
  doi          = {{10.2340/actadv.v105.40727}},
  volume       = {{105}},
  year         = {{2025}},
}