Systematic review and meta-analysis shows dermoscopy-guided excision reduces incomplete excision in keratinocyte cancer

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Clinical and experimental dermatology Published May 26, 2026 Medically reviewed May 26, 2026 Study authors: Vosinakis Christos, Hurley Anna R, Pinder Richard M, Matteucci Paolo L, Totty Joshua P PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note reduced incomplete excision with dermoscopy-guided excision in keratinocyte cancer, but evidence is observational.

This systematic review and meta-analysis examined the impact of dermoscopy-guided excision compared to conventional surgical excision on incomplete excision rates in keratinocyte cancer. The analysis included 1151 patients and 1186 lesions across multiple studies. The primary outcome measured was the incomplete excision rate, with secondary outcomes including surgical precision, recurrence outcomes, and margin control.

The pooled odds ratio for incomplete excision was 0.30, with 95% confidence intervals 0.27-0.34 and P < 0.001. This indicates a reduction in incomplete excision with the dermoscopy-guided approach. However, all included studies were observational and carried a moderate to serious risk of bias. The evidence remains limited by these methodological constraints.

Data for squamous cell carcinoma were specifically limited within the review. Serious adverse events, discontinuations, and tolerability were not reported. The authors note that evidence remains limited by methodological constraints and caution against overstatement of the evidence as definitive. Further high-quality trials are needed to confirm clinical utility and define its role in future surgical guidelines.

Study Details

Study typeMeta analysis

Sample sizen = 1,151

EvidenceLevel 1

PublishedMay 2026

PMID41517995

View Original Abstract ↓

BACKGROUND: Keratinocyte cancer (KC) is the most common malignancy worldwide. Surgical excision is the primary treatment, with clear margin delineation critical for oncological and cosmetic outcomes. Dermoscopy, well established for diagnosis, has recently been included in updated British guidelines as an alternative method for surgical margin planning and may offer improved border visualization. OBJECTIVES: To update the existing evidence on dermoscopy-guided excision of KC, focusing on margin control and recurrence risk and incorporating newly published studies and re-evaluating its use considering evolving guideline recommendations. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, EMBASE and CENTRAL were searched to October 2024. Eligible studies compared dermoscopy-guided with conventional surgical excision of histologically confirmed KC. The primary outcome was the incomplete excision rate. Risk of bias was assessed using ROBINS-I, and meta-analysis was conducted using a DerSimonian-Laird random-effects model. RESULTS: Ten studies (1151 patients; 1186 lesions) were included; 4 contributed to meta-analysis. Most focused on basal cell carcinoma; squamous cell carcinoma data were limited. Dermoscopy was associated with improved surgical precision and reduced incomplete excision (pooled odds ratio 0.30, 95% confidence intervals 0.27-0.34, P < 0.001; I² = 0%, P > 0.99), although all studies were observational and at moderate to serious risk of bias. Narrower margins were often achieved without compromising recurrence outcomes. CONCLUSIONS: Dermoscopy may enhance preoperative planning in KC excision, but evidence remains limited by methodological constraints. These findings support further high-quality trials to confirm clinical utility and define its role in future surgical guidelines.