Basosquamous Carcinoma: A Single Centre Clinicopathological Evaluation and Proposal of an Evidence-Based Protocol

Box 1

Using the data presented in this study in conjunction with published reports, a proposed unit protocol has been designed to guide treatment and follow-up for patients diagnosed with BSC.

At time of diagnostic surgery

(i) Punch or incision biopsy of suspicious lesion, or

(ii) If easily excisable measure and mark peripheral margins as per BCC guidance i.e. 4mm

(iii) Always ensure next clear anatomical plane is reached at the deep margin

(iv) If the lesion is suspicious of SCC, excise according to appropriate (EDF/BAD) SCC guidelines.

(v) In the case of confirmed BSC preoperatively, MMS should be offered where available

At first clinic review

(i) Explain difference between BSC and BCC i.e. whilst BSC has the potential for regional and

distant metastasis, this is uncommon in pT1 & pT2 lesions, without deep invasion of the tumour

(ii) Full examination of excision site and regional nodes

Subsequent follow-up

(i) All patients to have full examination of excision site and regional nodes

(ii) Completely excised pT1 & pT2 BSC – follow up 3-4 monthly for 24 months, then discharge if well

(iii) Incompletely excised pT1 & pT2 BSC – offer wider excision or radiotherapy after Skin

MDT discussion, follow up 3-4 monthly for 24 months, then discharge if well

(iv) All pT3 & pT4 BSCs, and those with invasion into deep structures e.g. fascia, muscle, cartilage or bone,

require Skin MDT discussion, appropriate treatment and follow-up 3-4 monthly for 3 years, and then

6 monthly to total of 5 years follow up.