• K M McKay, B L Sambrano, P S Fox, R L Bassett, S Chon, and V G Prieto.
• Departments of Dermatology and Pathology, The University of Alabama at Birmingham, Birmingham, AL, U.S.A.
• Br. J. Dermatol. 2013 Sep 1; 169 (3): 549-54.

BackgroundBasal cell carcinoma (BCC) is the most common malignancy in the white population. It is an important driver of healthcare costs and causes significant morbidity. Topical imiquimod is a good noninvasive treatment alternative for surgical excision in superficial BCC (sBCC). However, there are currently no uniform histological definitions of sBCC. A definition based on tumour thickness might be a good alternative.ObjectivesTo determine whether tumour thickness in sBCC is a predictor of treatment failure.MethodsWe retrospectively examined 127 histological biopsy specimens of sBCC treated primarily with imiquimod five times a week for 6 weeks. Mean follow-up was 34 months (range 3-91). Recurrence was evaluated clinically with histological verification.ResultsAmong nonrecurrent cases the median tumour thickness was 0·26 mm (range 0·09-0·61), while for recurrent cases the median tumour thickness was 0·57 mm (range 0·41-1·41, P < 0·0001). Among lesions ≤ 0·40 mm in thickness, none recurred, whereas for lesions > 0·40 mm the recurrence rate was 58% (P < 0·0001).ConclusionsWe recommend the use of tumour thickness to define the superficial pattern in pathology reports for BCC as this can help to determine treatment response of sBCC to imiquimod.© 2013 British Association of Dermatologists.

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