Application of high-frequency ultrasound and dermoscopy in precise preoperative evaluation of basal cell carcinoma / 中华皮肤科杂志

ABSTRACT

Objective To evaluate the application value of ultrasound and dermoscopy in the precise preoperative evaluation of basal cell carcinoma (BCC),and to analyze the association of high-frequency ultrasound and dermoscopic findings with pathological recurrence risk of BCC.Methods Clinical data were collected from 33 outpatients with confirmed BCC in the Department of Dermatology,Peking Union Medical College Hospital between April 2016 and December 2018,and high-frequency ultrasonographic and dermoscopic findings from 36 BCC lesions were analyzed.The lesions were classified into high-risk and low-risk groups based on pathological findings.Statistical differences in ultrasound and dermoscopic characteristics between high-risk and low-risk BCC groups were analyzed by using Fisher's exact test,and the correspondence between high-frequency ultrasonographic and dermoscopic features of BCC was analyzed by calculating the simple matching coefficient.Results Of the 36 BCC skin lesions,4 were high-risk lesions and 32 were low-risk lesions.Ultrasonographic features of the high-risk and low-risk lesions overlapped markedly,and no significant differences were observed between the high-risk and low-risk lesions with regard to the shape,boundary,internal echo,hyperechoic spots,or posterior echo (all P ＞0.05).However,24 (75.0％) low-risk lesions were confined to the dermis,whereas 4 high-risk lesions involved the subcutaneous tissue,and there was a significant difference between the high-risk and low-risk BCC groups with regard to the distribution of BCC (P =0.008).In 5 BCC lesions,ultrasound could identify small easy-to-ignore lesions or deep and invisible lesions besides obvious lesions.There were no significant differences in dermoscopic features between high-risk and low-risk groups.However,none of spoke-wheel area,milky-red structureless area,milia-like cysts,comedo-like openings and rainbow pattern was observed in 4 high-risk BCC lesions.The simple matching coefficient between enhanced hyperechoic spots in the lesion observed by ultrasound and milia-like cysts under a dermoscope was 36.1％,and the simple matching coefficient between discontinuous hyperechoic echo in the epidermis on ultrasonography and ulcer/erosion under a dermoscope was 75.0％.Conclusion High-frequency ultrasound and dermoscopy both provide important information for preoperative evaluation of risk of BCC lesions,and high-frequency ultrasound can identify easy-to-ignore hidden lesions in clinical practice.