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Biopsy Versus Reflectance Confocal Microscopy in Diagnosis of Basal Cell Carcinoma

By: Joshua D. Madera, MS
Posted: Monday, August 17, 2020

Punch biopsy seems to be a more effective clinical measure than reflectance confocal microscopy in accurately identifying a a diagnosis of basal cell carcinoma, according to a study published in the British Journal of Dermatology. Moreover, “this outcome does not support routine clinical implementation of reflectance confocal microscopy,” reported Satish F.K. Lubeek, MD, PhD, of Radboud University Medical Center, The Netherlands, and colleagues.

A total of 288 patients suspected of primary basal cell carcinoma were recruited from four hospitals and enrolled in the study. All patients were randomly assigned to receive one of two diagnostic measures: punch biopsy or reflectance confocal microscopy. Procedures were followed by surgical excision or follow-up for further assessment. The subtype of basal cell carcinoma was characterized based on aggressiveness (infiltrative or micronodular vs. superficial or nodular), histopathology, and level of depth (superficial vs. nonsuperficial).

The investigators did not identify any differences in the sensitivity for both diagnostic measures (99% for reflectance confocal microscopy vs. 99% for punch biopsy). However, the specificity for punch biopsy (100%) was higher than that for reflectance confocal microscopy (59%). In addition, analysis of aggressive subtypes of basal cell carcinoma revealed a decreased sensitivity for reflectance confocal microscopy (33.3%) as compared with punch biopsy (77.3%). In contrast, assessment of nonsuperficial basal cell carcinoma did not reveal any differences between the two diagnostic measures (88.9% vs. 91.0%). Furthermore, reports on patient satisfaction and patient preference revealed comparable sentiments regarding both diagnostic methods.

Disclosure: For full disclosures of the study authors, visit

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