Figure - available from: Dermatologic Therapy
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Basal cell carcinoma (BCC), micronodular, on right lateral side wall of nose adjacent to the internal canthus. (A) Clinical features and initial demarcation prior to dermoscopy (dashed light blue line). (B) Dermoscopy image showing blue‐gray globules, arborizing telangiectasia, and MAY globules on the periphery (red arrows). Dermoscopic delineation is shown with dashed black lines (Polarized image, original magnification 10×). (C) Final demarcation of intended first stage after including MAY globules. (D) Final defect after 2 stages. (E) Histopathology, Mohs micrographic surgery (MMS) first stage, en face view, showing tumor islands of micronodular BCC with calcium deposits (black rectangle) on deep and lateral margins (H&E, 2×). (F) Higher magnification of the dystrophic calcification in tumor nodule (center of the image) (H&E, 20×). (G) Second MMS stage, en face view, with no further evidence of tumor (H&E, 2×)
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... Fourteen full-text articles were assessed for eligibility. Among these, 4 were excluded (case reports and noncomparative studies) [16][17][18][19]. Three research letters were excluded [11,20,21]. ...
Introduction:
Several studies investigated the use of dermoscopy in the delineation of basal cell carcinoma (BCC) for Mohs micrographic surgery (MMS) with conflicting results.
Objectives:
The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of the use of dermoscopy-guided MMS in the treatment of BCC.
Methods:
We included all comparative studies. Cases of BCC treated using dermoscopy-guided MMS (or slow MMS) were compared to those treated with curettage-guided MMS or "standard" MMS.
Results:
A total of 6 studies including 508 BCCs were reviewed. There was no statistically significant difference in the proportion of total margin clearance on the first MMS stage between BCCs removed using dermoscopy-guided MMS and those that had curettage or visual inspection. However, lateral margin involvement was significantly lower in BCCs that had dermoscopy-guided MMS.
Conclusions:
Dermoscopy allows visualization of structures up to 1mm into the dermis. Therefore, it is rational to use it for lateral margin evaluation. Currently, there are two comparative studies showing the efficacy of dermoscopy for lateral margin evaluation during MMS. Future studies are required to develop an evidence-based recommendation regarding the utility of dermoscopy in MMS.
