Investigations
1st investigations to order
biopsy for dermatohistopathology
Test
The diagnosis of a cancer is histological; it is advisable to perform either a shave biopsy or punch biopsy.[44][48]
Punch biopsy is best used in cosmetically non-challenging areas. An advantage of punch biopsy is that the tools may be available in sizes of up to 12 mm. Accordingly, lesions smaller than this can be removed in a single procedure, facilitating simultaneous diagnosis and treatment.[49]
Reserve shave biopsy for cosmetically challenging areas such as the face.
Result
growth of nest(s) of varying size and shape, either tightly associated with epidermis or follicular opening; neoplasm composed of basophilic (blue) hyperchromatic cells, with high nuclear-cytoplasmic ratio, and so-called peripheral palisading (on the edges of the neoplastic nests, nuclei of malignant cells are arranged in a manner similar to a picket fence); stroma surrounding BCC is hypercellular, fibrous; commonly, there is a separation (retraction) artefact between nests of neoplastic cells and the stroma (so-called stroma-epithelium split); additionally, in conjunction with the stroma, pools of blue dermal mucin (increase in dermal glycosaminoglycans) are identified
Emerging tests
in vivo multiphoton microscopy
Test
Uses non-invasive, label-free in vivo imaging to reveal several characteristic features of basal cell carcinoma lesions that may help facilitate diagnosis.[50] Dermatoscopic and reflectance confocal microscopic technologies have become a popular method for non-invasive approaches to aid in the diagnosis of basal cell carcinomas.[46][51][52] Adding artificial intelligence to non-invasive imaging has tremendous potential and is the subject of active investigation.[51] However, further research is needed to isolate pooled diagnostic accuracy.[51]
Result
nests of basaloid cells showing palisading in the peripheral cell layer at the dermoepidermal junction and/or in the dermis
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