Histopathologic Reporting of Non-Melanoma Skin Cancers and Implications for Treatment

Summary: Objectives: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) account for 95% of non-melanoma skin cancers (NMSC), with 5.4 million cases annually. This study aims to identify disparities in the diagnosis of NMSC by comparing initial biopsies with final pathologic specimens, and the potential impact of biopsy depth and anatomic location on the accuracy of histologic subtyping. Methods: A retrospective review was conducted at Wake Forest Baptist Medical Center identifying NMSC. Specimens with discordance between initial biopsy and final pathologic diagnosis at the time of definitive treatment (Mohs micrographic surgery or excision) were included. Data collected included demographics, biopsy dimensions, anatomical location, and time to treatment. Results: 793 cases were identified, and 306 cases were included. Of the 306 cases, 40 (13.1%) displayed upgraded pathologies from biopsy to treatment. Of the upgraded cases, tumors located on the ear (27.5%), scalp (17.5%), and nose (15%) exhibited the highest rates of diagnostic discrepancies between initial biopsy and final excision. Conclusion: Our findings suggest that anatomical location of the tumor plays a role in histologic discordance. This may reflect inadequate sampling at sensitive areas such as the ear, scalp and nose. Research Funding: Kulynch Endowed Interdisciplinary Cancer Research Fund (WFUSOM MSRP)