Tests
1st tests to order
biopsy for dermatohistopathology
Test
The diagnosis of a cancer is histologic; it is advisable to perform either a shave biopsy or punch biopsy.[44][48]
Punch biopsy is best used in cosmetically nonchallenging 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) artifact 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 noninvasive, 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 noninvasive approaches to aid in the diagnosis of basal cell carcinomas.[46][51][52] Adding artificial intelligence to noninvasive 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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