About Mapping Biopsies
Mapping biopsies are performed prior to treatment planning of the skin cancer. Although the extent of most skin cancers could be easily determined with visual inspection and digital palpation, some lesions are not so obvious. Preparing the patient for treatment plan requires knowledge of the extent of a possible carcinoma. Whether it is Mohs surgery or radiation therapy planning, both cases would benefit from knowing the margins of the cancer involvement. Imaging frequently fails in staging local extent of the skin cancers. Therefore, the only modality left for adequate staging the cancer and predicting possible surgical defect is with mapping biopsies.
Mapping biopsies can be performed in the office setting under local anesthesia, but occasionally require IV sedation and surgical setting for patient's comfort. A 2-3 mm punch biopsies and shaved biopsies can be used to map out skin cancer involvement in the surrounding area. Both cancer-free biopsies and cancer involved biopsy results require to adequately map the cancer. In our Center, we use a minimum of four biopsies to as many as 20 biopsies to stage various cancers. Cancers involving paranasal area frequently require intranasal biopsies to rule out full-thickness involvement or intranasal and mucosal involvement. Intranasal biopsies require the use of nasal endoscope and an otolaryngologist to obtain them.
Once mapping biopsies defined what the cancer involves and does not involve, the patient can be adequately prepared for the reconstructive surgery necessary. At that point, a determination can also be made whether Mohs surgery can be done under local anesthesia _____ best be done in the operating room setting under IV sedation. Finally, involvement of bone with deeply invasive carcinoma is of great importance to predict whether bone resection is necessary. This way, the patient can be prepared for both Mohs excision of soft tissue portion of carcinoma and subsequent radical bone resection under the tumor and with delay of reconstruction. The latter is necessary in order for bone to be decalcified and histologically evaluated for cancer involvement.
Finally, mapping biopsies are very useful in determining the extent of radiation necessary. If the tumor is limited, then simple office-based superficial radiotherapy could be utilized. If the tumor is much more involved requiring a 3-dimensional application of radiation energies, then hospital-based electron beam radiation therapy would be required.
Mapping biopsy is an underutilized modality, but would avoid patient's surprises, physician surprises, and inadequate surgical planning of cancer treatment.
Acceptance of residual melanoma-in-situ (lentigo maligna) after an excision can avoid cosmetic and functional deformation. Is the residual risk of recurrence and transformation into invasive melanoma low enough to warrant observation? Melanoma-in-situ (MIS) is a high risk lesion due to three primary reasons. The first is that a partially biopsied melanocytic lesion with a diagnosis…Read More
HISTORY 85-year-old man presented in March 2015 with a multi-year history of a non-healing right lower leg lesion. Shave biopsy found squamous cell carcinoma in situ with focal areas of early invasion. Superficial radiotherapy was prescribed at 50 kvp 5 days per week for 5 weeks ending in July 2015. Minor skin erosion present 3…Read More
PET scanning is utilized in skin cancer staging by detecting regional lymph node metastases as well as distant organ metastases. Its specificity is superior to CT and MR for N-staging, particularly with melanoma. It can be the superior modality for primary tumor staging as well. PET scan imaging is based on the increased metabolic activity…Read More
HISTORY 63 year old woman diagnosed with recurrence of BCC of left upper lip in 2015 after treatment of Efudex and a surgical excision in 2005. Patient had 3 separate BCC locations in left upper lip. Due to the size and multifocality of the lesion, patient was treated with Erivedge for 7 months with a…Read More
DISCUSSION This series of large forehead defects features a frequent common theme of reconstruction. The goal of reconstruction is protection of eyebrow position and prevention of upper eyelid retraction. If tension was placed on the eyebrow with a large forehead flap, upper eyelid can suffer from a cicatricial lagophthalmos. Incomplete closure of the eyelid…Read More
Metatypical basosquamous cell carcinoma is a subset of cutaneous cancers that poses an increased risk of metastases to the patient due to its aggressive behavior. The classic histology of metatypical basosquamous cell carcinoma includes features of both basal cell carcinoma and squamous cell carcinoma, as well as areas of intermediate differentiation. The cells are larger and…Read More
STAY UP TO DATE
Sign up for our newsletter!
Collaborate on a Patient
Coordinate a Mohs procedure with our surgeons. Operate at our surgery center.
PRESENT AT SCARS TUMOR CONFERENCE
SCARS Foundation Monthly Skin Cancer Conference is CME Accredited.