Skin cancer surgery aims to remove the tumor completely without damaging healthy tissue. But sometimes surgeons miss a few cells, leaving the disease behind. A new analysis looked at 1151 patients who had keratinocyte cancer. These patients had either 1186 lesions removed with standard surgery or with dermoscopy guidance. Dermoscopy lets doctors see the skin surface clearly before cutting. The results showed that using this visual guide reduced the rate of incomplete excision. In plain terms, fewer cancer cells were left behind when doctors used the dermoscopy tool. The data showed a strong reduction in incomplete removal across the group. This matters because leaving cells behind can lead to the cancer returning or needing more surgery. The study also looked at surgical precision and margin control. Both improved when dermoscopy was used. However, the researchers noted that all the studies were observational. This means they watched what happened without controlling every detail. There was a moderate risk of bias in the data. The evidence for squamous cell carcinoma specifically was limited. Because of these methodological constraints, the findings are not yet definitive. We need more high-quality trials to confirm how useful this tool is. Until then, this approach shows promise for improving surgical outcomes.
Systematic review and meta-analysis shows dermoscopy-guided excision reduces incomplete excision in keratinocyte cancerDermoscopy-guided cuts reduce incomplete removal of skin cancer lesions
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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.
What this means for you:
Dermoscopy guidance lowers incomplete excision rates for keratinocyte cancer lesions. More on Cancer
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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.
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