Review Finds Dermoscopy Can Reduce Incomplete Excision of Skin Cancer

Use of dermoscopy, which uses a handheld light to examine cutaneous lesions prior to surgery for skin cancer, reduces the likelihood of cancer remaining in surgical margins following excision, according to a recent review of 6 studies involving 592 patients.

The review, which appeared recently in Journal of Clinical and Aesthetic Dermatology, examined what ther authors called a “relatively inexpensive and readily available” tool to reduce rates of incomplete excision. The authors, from the Department of Plastic and Reconstructive Surgery at Hull University Teaching Hospitals in the United Kingdom, noted that most surgeons in skin cancer clinics would be familiar with the method.

“However,” they wrote, “the quality of the available evidence is low, and at significant risk of bias, and therefore further research is required in this area.”

Authors screened 452 studies for eligibility for their study and found 6 that met criteria of the review, which sought to examine whether the use of dermoscopy as an adjunct to clinical examination could improve rates of incomplete excision in nonmelanoma skin cancer lesions.

The authors noted as limitations that the overall number of available studies was small and that 3 of the studies selected were performed by the same team. There were 5 studies involving patients with basal cell carcinomas (498 patients) and 1 with patients who had squamous cell carcinomas (94 patients).

The odds ratio (OR) of incomplete excision when guided by dermoscopy was 0.29 (95% CI, 0.25-0.34). Heterogeneity was assessed, and the I² statistic was found to be 0%. Of note, all 6 studies found that dermoscopy improved the likelihood of complete excision.

To the authors’ knowledge, “this is the first systematic review that has focused on the comparison of dermoscopy as an intervention in marking of surgical margins to determine the primary outcome of incomplete excision rate.”

Nonmelanoma skin cancers removed with surgery are typically on the head and neck due to ultraviolet light exposure, and incomplete excision rates have been reported to be 10% to 17%, with higher rates for periorbital excisions.

There are many risks with incomplete excision, including recurrence requiring additional treatment. “In cosmetically sensitive areas, the aesthetic outcome sometimes overshadows the aim of oncological clearance and so as little tissue is removed as possible to minimize the defect size through compromising on the oncological margin,” they wrote.

Despite the low cost and availability of dermoscopy, the authors said training is limited outside the field of dermatology. With more patients likely to present with skin lesions, however, the authors recommended that more physicians be trained in dermoscopy, especially surgeons.

“We would recommend that dermatoscopes be routinely available and used in operating departments, that training in their use be provided for surgeons, and that measurement of excision margins, along with the use or otherwise of dermoscopy, be recorded to aid future analysis of the utility of dermoscopy,” they wrote.

Reference

Hurley AR, Totty JP, Pinder RM. Dermoscopy as an adjunct to surgical excision of nonmelanoma skin lesions: a systematic review and meta-analysis. J Clin Aesthet Dermatol. 2022;15(9):45-49. doi:10.1016/j.ejso.2021.11.074