Study On Non-invasive Detection Methods For Defining The Margins Of Basal Cell Carcinoma Before Operation

ObjectiveThe definition of surgical safety margins of Basal cell carcinoma(BCC)is the key in the treatment of skin tumor surgery.Despite mohs micrographic surgery(MMS)can excise tumor precisely,but the processes were complex,time consumed,the operation safety is not good,and the clinical efficiency is relatively lower.The purpose of this study is to explore the feasibility of detecting the margins of basal cell carcinoma by Dermoscopy,5-aminolevulinic acid(ALA)fluorescence localization,reflectance confocal microscopy(RCM)and high-frequency ultrasound,and to reverse comparison with the scope of resection of Mohs micrographic surgery,and to provide reference for the evaluation of the surgical margins before operation.MethodsA total of 32 patients were diagnosed as BCC by pathology in the Department of Dermatology of the First Affiliated Hospital of Kunming Medical University from December 2016 to December 2017,combined with the patients’ skin lesions,characteristics and their wills to use the dermoscopy,ALA fluorescence location,and RCM to observe and measure the lesion and its margins,the depth of infiltration was measured by high frequency ultrasound,and then,surgical excision was performed,the tissues were removed for frozen section pathological examination until the margin should tumor cell negative.The tumor’s margins detected by several methods were compared with the sizes by astral lamp,security margins,surgical margins,and statistic analysis.Result1.The skin lesions of the patients with basal cell carcinoma have been detected by skin microscopy,ALA fluorescence localization and RCM,and there were significant differences compared with the naked eye boundary detection and surgical resection size.2.Astral lamp observation,dermoscopy and ALA fluorescence localization,RCM.The safety margins and resection size compared each other,in addition to the detection of dermoscopy and ALA fluorescence localization size had no difference in statistics,there were significant differences in the other groups.3.Compared with the size of the tumor resection,the Pearson values of the dermoscopy,ALA fluorescence and RCM were 0.948,0.901,and 0.934 respectively.4.The final resection size was extended to 2.93mm,2.89mm,and 1.41mm cm the basis line of dermoscopy,ALA fluorescence location,and RCM detection size.5.The bottom of samples of these 4 patients with BCC who underwent 50MHz high frequency ultrasound before operation should negative by pathologic detection after resection.ConclusionAccording to the characteristics of different lesions of the patient,using dermoscopy,ALA fluorescence location,RCM or high frequency ultrasound to detect the margin of BCC before,would reduce risks of operation and improve working effects.And it would exert profound influence in dermatologic surgery.