Non-Melanoma Skin Cancers Coverage from Every Angle

Can High-Frequency Ultrasound Improve Accuracy of Identifying Basal Cell Carcinoma?

By: Celeste L. Dixon
Posted: Tuesday, April 13, 2021

Although pathologic assessment of skin tumors via biopsy remains the “gold standard” to diagnose basal cell carcinoma, better ways to perform noninvasive examinations are always useful to help avoid, when possible, biopsy’s potential permanent scars, especially on the face. High-frequency ultrasound should be used more frequently for this purpose, as well as for identifying basal cell carcinomas at the earliest possible time, according to Hongzhong Jin, MD, of Peking Union Medical College, Beijing, China, and colleagues. Their work about the modality’s underappreciated utility is published in Skin Research and Technology.

Occasionally, basal cell carcinoma can appear similar to that of some benign pigmented skin lesions, such as melanocytic nevi and seborrheic keratosis. From their study of 54 known basal cell carcinomas, 51 melanocytic nevi, and 55 seborrheic keratoses, the team determined that several sonographic signs were statistically significant indicators of basal cell carcinoma. “Anechoic areas and epidermal interrupted echo were the strongest indicators for [cancer] diagnosis when present, followed by irregular shape and subcutaneous tissue invasion,” they wrote. Also significantly associated with malignancy were ill-defined margins (P < .001) and hyperechoic spots (P = .001).

Conversely, the researchers made a novel observation related to nonmalignant tumors. They noticed that when a high-resolution ultrasound reveals a tumor has certain similarities to a mushroom—a “cap” with clear boundaries, a “stalk”—the finding “has high specificity and positive predictive value in diagnosing melanocytic nevi,” they wrote.

Dermatologists should consider high-frequency ultrasound when they are unsure about a lesion type after examination with the naked eye and dermoscopy, concluded the authors. It can improve the accuracy of basal cell carcinoma identification without biopsy, but it can help to detect the optimal biopsy location should one ultimately need to be done and provide information such as tumor depth in the event of later full removal.

Disclosure: The study authors’ disclosure information can be found at

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