Importance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas

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dc.contributor.authorCeder, Hannah
dc.contributor.authorBackman, Eva
dc.contributor.authorMarghoob, Ashfaq
dc.contributor.authorNavarrete-Dechent, Cristian
dc.contributor.authorPolesie, Sam
dc.contributor.authorReiter, Ofer
dc.contributor.authorPaoli, John
dc.date.accessioned2025-01-20T16:10:47Z
dc.date.available2025-01-20T16:10:47Z
dc.date.issued2024
dc.description.abstractIntroduction: Being able to recognize high-risk facial basal cell carcinoma (BCC) may lead to fewer incomplete excisions and inappropriate treatments. Objectives: We sought to investigate clinical and dermoscopic criteria for predicting facial BCC subtypes, analyze the interobserver agreement between readers, and develop a diagnostic algorithm to predict high-risk histopathological subtype. Methods: In this single-center, retrospective investigation, 6 independent readers evaluated predefined clinical and dermoscopic criteria in images of histopathologically verified primary facial BCCs including: topography, border demarcation, vessels, ulceration, white porcelain areas, shiny white blotches and strands, and pigmented structures and vessels within ulceration. Results: Overall, 297 clinical and dermoscopic image pairs were analyzed. The strongest associations with high-risk subtype were: "bumpy" topography (OR 3.8, 95% CI, 3.1-4.7), ill-defined borders (OR 3.4, 95% CI 3.1-4.7), white porcelain area (OR 3.5, 95% CI 2.8-4.5), and vessels within ulceration (OR 3.1, 95% CI 2.4-4.1). Predominantly focused vessels were a positive diagnostic criterium for either nodular (OR 1.7, 95% CI 1.3-2.2) or high-risk (OR 2.0, 95% CI 1.6-2.5) subtypes and a strong negative diagnostic criterium for superficial BCC (OR 14.0, 95% CI 9.6-20.8). Interobserver agreement ranged from fair to substantial (kappa = 0.36 to 0.72). A diagnostic algorithm based on these findings demonstrated a sensitivity of 81.4% (95% CI, 78.9-83.7%) and a specificity of 53.3% (95% CI, 49.7-56.9%) for predicting high-risk BCC subtype. Conclusions: Integration of both clinical and dermoscopic features (including novel features such as topography and vessels within ulceration) are essential to improve subtype prediction of facial BCCs and management decisions.
dc.fuente.origenWOS
dc.identifier.doi10.5826/dpc.1403a212
dc.identifier.issn2160-9381
dc.identifier.urihttps://doi.org/10.5826/dpc.1403a212
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90230
dc.identifier.wosidWOS:001286343700001
dc.issue.numero3
dc.language.isoen
dc.revistaDermatology practical & conceptual
dc.rightsacceso restringido
dc.subjectbasal cell carcinoma
dc.subjectdermoscopy
dc.subjectclinical decision-making
dc.subjectinterobserver agreement
dc.subjectMohs micrographic surgery
dc.subjectalgorithm
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleImportance of Both Clinical and Dermoscopic Findings in Predicting High-Risk Histopathological Subtype in Facial Basal Cell Carcinomas
dc.typeartículo
dc.volumen14
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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