Basal cell carcinoma - Clues to its presence in histologic sections when the initial slide is nondiagnostic

Initial sections of skin biopsies may not be diagnostic of basal cell carci noma (BCC). Are there histologic predictors of BCC that should prompt deepe r sections? Ninety-four cases in which the clinical diagnosis was BCC or "r ule-out BCC," and the initial histologic slides were nondiagnostic, were su bmitted for deeper sections on three additional slides. Of the 94 cases, 50 (53%) demonstrated BCC on deeper sections. This relatively high incidence suggests that deeper sections should be taken in all cases of clinically su spected BCCs unless alternate histologic findings adequately account for th e clinical lesion. The results of this study suggest that additional sectio ns are more likely to yield BCC when the initial nondiagnostic slide demons trates focal epidermal atypia, equivocal adnexae, stromal fibrosis, empty d ermal space, and microcalcifications, criteria which may be useful in deter mining the need to do deeper sections in cases in which BCC is not clinical ly suspected.