Histopathological Discrepancy Between Biopsy and Mohs Surgery or Wide Local Excision Carcinomas: A Systematic Review
The aim of this systematic review is to analyze the histopathological discrepancy between biopsy and definitive surgical treatment by determining discrepancy and upstaging rates. A primary literature review was conducted on histopathological discrepancies between biopsy and MMS or WLE with PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL databases. Twenty eight studies, encompassing 10850 BCCs and 3049 SCCs were included for analysis. 18 studies included MMS (Mohs Micrographic Surgery) cases and 8 studies on wide local excision (WLE), whereas 2 studies featured both MMS and WLE as the treatment modalities. The average discordance rate for BCC and SCC was 31.10% (range: 17.00-59.5%) and 16.67%, respectively; whereas the total discordance rate for non-melanoma skin cancer (NMSC) was 37.56% (range: 17.70-61.00%). The rate of upstaging for BCC was 18.86% (range: 15.00-22.60%) and that of SCC was 22.74% (range: 3.00-66.00%). These results suggest that variability in interpretation, diagnostic criteria, and reporting by dermatopathologists and biopsy sampling error can result in a change in diagnosis. Mohs surgeons should be vigilant for more aggressive subtypes within the lesions being sampled and the limitation of pre-operative biopsies in the management of NMSC diagnosis.