Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases
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...
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Medical Journals Sweden
2025-01-01
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| Series: | Acta Dermato-Venereologica |
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| Online Access: | https://medicaljournalssweden.se/actadv/article/view/40727 |
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| author | Katherine Hopkins Åsa Ingvar Johan Palmgren Valdis Thorhallsdottir Kari Nielsen Karim Saleh |
| author_facet | Katherine Hopkins Åsa Ingvar Johan Palmgren Valdis Thorhallsdottir Kari Nielsen Karim Saleh |
| author_sort | Katherine Hopkins |
| collection | DOAJ |
| description | 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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| format | Article |
| id | doaj-art-1fe0c3090bcc447ca69ced4ea00b20bb |
| institution | Kabale University |
| issn | 0001-5555 1651-2057 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Medical Journals Sweden |
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| series | Acta Dermato-Venereologica |
| spelling | doaj-art-1fe0c3090bcc447ca69ced4ea00b20bb2025-01-03T08:46:04ZengMedical Journals SwedenActa Dermato-Venereologica0001-55551651-20572025-01-0110510.2340/actadv.v105.40727Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 CasesKatherine Hopkins0Åsa Ingvar1Johan Palmgren2Valdis Thorhallsdottir3Kari Nielsen4Karim Saleh5Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDivision of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDivision of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDivision of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDivision of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenDivision of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, SwedenThe 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. https://medicaljournalssweden.se/actadv/article/view/40727Cutaneous squamous cell carcinomapunch biopsyexcisional biopsydiagnostic concordancehistopathologytumor size |
| spellingShingle | Katherine Hopkins Åsa Ingvar Johan Palmgren Valdis Thorhallsdottir Kari Nielsen Karim Saleh Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases Acta Dermato-Venereologica Cutaneous squamous cell carcinoma punch biopsy excisional biopsy diagnostic concordance histopathology tumor size |
| title | Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases |
| title_full | Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases |
| title_fullStr | Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases |
| title_full_unstemmed | Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases |
| title_short | Histopathological Diagnostic Discordance between Punch Biopsies and Final Diagnostic Excisions of Cutaneous Squamous Cell Carcinoma: Analysis of 737 Cases |
| title_sort | histopathological diagnostic discordance between punch biopsies and final diagnostic excisions of cutaneous squamous cell carcinoma analysis of 737 cases |
| topic | Cutaneous squamous cell carcinoma punch biopsy excisional biopsy diagnostic concordance histopathology tumor size |
| url | https://medicaljournalssweden.se/actadv/article/view/40727 |
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