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-nine studies, encompassing 10850 BCCs and 3049 SCCs were included for analysis. 19 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 2,428 non-melanoma skin cancer cases (studies combining BCC and SCC) was 38.5% (range:17.7-61.0%), 1,825 BCC cases was 30.7% (range: 17.0-59.5%), and 264 SCC cases was 18.4% (range: 3.0-39.7%). The rate of upstaging for 734 BCC cases was 18.9% (range:15.0-22.6%) and for 376 SCC cases was 22.7% (range: 3.0-66.0%). The discordance rate among 1,470 punch biopsies was 28.4% (range: 11.0-40.4%) versus 1,564 shave biopsies, which was 17.6% (range: 19.0-28.7%). Analysis of 2,079 debulk BCC specimens revealed an average discordance rate of 30.9%, whereas 817 cases of debulk SCC specimens had a discordance rate of 11.4%. 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.