Track

Clinical Studies

Abstract

Background. Basal cell carcinoma (BCC) is the most common skin cancer. WHO classification broadly stratifies BCC into high- and low-risk subgroups, based on biologic behavior and therapeutic implications. Shave biopsy is a primary modality of ruling in BCC, whereas definitive subtyping is based on excision specimen assessment. Objective. To assess common and unique morphologic features associated with risk classification of BCC in shave biopsy specimens. Methods. A retrospective review was conducted of 293 shave biopsy specimens with an original rendered diagnosis of BCC at the Kansas City VA Medical Center (KC VAMC) from 2021-2024. Slides were reviewed and morphologically characterized by a resident and independently by a board-certified pathologist. Only 263 cases with complete agreement upon morphologic characteristics were analyzed. Eleven morphologic characteristics and 37 qualifiers were assessed. Results. Significant association with risk classification was observed for the following features: ulceration (χ²(1) =4.32, p < 0.05), silhouette (χ²(4) =42.6, p < 0.001), infiltrative appearance (χ²(3) =43.5, p < 0.001), peripheral palisading (χ²(2) =7.14, p < 0.05), and pleomorphism (χ²(2) =7.24, p < 0.05). Conclusion. Attention to particular morphological characteristics of BCC in shave biopsy specimens could potentially help stratify tumors into high- or low-risk categories and guide further management.