What are the AAD biopsy diagnostic guidelines for basal cell carcinoma (BCC)?

Updated: Mar 23, 2021
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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The AAD guidelines recommend the following biopsy techniques for basal cell carcinoma (BCC) [110] :

  • Punch biopsy
  • Shave biopsy
  • Excisional biopsy

AAD recommendations regarding biopsy are as follows:

  • The biopsy technique chosen will depend on the characteristics of the suspected malignancy (eg, morphology, location) and the judgment of the physician.
  • The biopsy specimen size and depth should be adequate to provide the recommended clinical information and pathology report elements to permit accurate diagnosis and guide therapy.
  • Repeat biopsy may be considered if initial biopsy specimen is inadequate for accurate diagnosis.

In cases of suspected BCC, the AAD guidelines strongly recommend providing the following clinical information when sending a biopsy specimen to the pathologist:

  • Patient age and sex
  • Anatomic location of the specimen
  • Whether the lesion is recurrent

   Providing the following information is recommended:

  • Size of lesion
  • Immunosuppression
  • History (especially radiation burn, organ transplant)

   On the final pathology report (on excision specimens), inclusion of the following information is recommended:

  • Histologic subtype
  • Invasion beyond reticular dermis

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