Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin

Abstract

Background Basal cell carcinoma (BCC) recurrences, especially in the facial region, represent a complex cosmetic problem. To date the possibility of predicting recurrence is supported solely by the histologic subtype. Objective To evaluate the relationship between BCC histologic subtypes linked to high and low risk of recurrence and the presence of hyperechoic spots on sonography. Methods Retrospective analysis of the pre-surgical ultrasound examinations of primary BCC tumours with visualization and counting of intra-tumoural hyperechoic spots. The data were then correlated with the corresponding histologic subtype. Results Thirty one patients with histologically proven BCC were included in the study. Hyperechoic spots were detected in all cases and there was a positive, statistically significant association between hyperechoic spots count and high recurrence risk histologic subtypes. Higher hyperechoic spots count was found in the recurrenceprone micronodular, sclerosing variant and morpheiform BCC subtypes. Low risk and high risk of recurrence showed a significant difference on the mean hyperechoic spots count of 5.5 (range: 3–25) and 8 (4–81). A cut-off point ≥7 hyperechoic spots presented a sensitivity of 79% and specificity of 53% for predicting the high risk of recurrence subtypes. Conclusion The presence and count of hyperechoic spots within BCC lesions may help predicting the high risk of recurrence histologic subtypes.