Journal of the European Academy of Dermatology and VenereologyEarly View LETTER TO THE EDITOR Poor correlation between diameter and Breslow thickness of melanoma E. Salijuma, Corresponding Author E. Salijuma [email protected] orcid.org/0009-0001-8005-4863 Dermatology Clinic: Prof. J. Kisis & Asst. Prof. Rone-Kupfere, Riga, Latvia Correspondence E. Salijuma, Dermatology Clinic: Prof. J. Kisis & Asst. Prof. Rone-Kupfere, Riga, Latvia. Email: [email protected]Search for more papers by this authorJ. Maskalane, J. Maskalane orcid.org/0000-0001-8340-9669 Dr. Maurins Laser Medical Clinic, Riga, LatviaSearch for more papers by this authorK. Lallas, K. Lallas Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorC. Papageorgiou, C. Papageorgiou orcid.org/0000-0003-4768-1758 Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorT. Gkentsidi, T. Gkentsidi orcid.org/0000-0003-1432-4789 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorS. M. Manoli, S. M. Manoli orcid.org/0000-0001-7450-5835 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorP. Eftychidou, P. Eftychidou First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorS. Sakellaropoulou, S. Sakellaropoulou First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorC. Nikolaidou, C. Nikolaidou Department of Histopathology, Ippokrateio General Hospital, Thessaloniki, GreeceSearch for more papers by this authorE. Vakirlis, E. Vakirlis First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorE. Sotiriou, E. Sotiriou orcid.org/0000-0001-6235-4718 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorZ. Apalla, Z. Apalla orcid.org/0000-0002-9255-8196 Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorA. Lallas, A. Lallas orcid.org/0000-0002-7193-0964 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this author E. Salijuma, Corresponding Author E. Salijuma [email protected] orcid.org/0009-0001-8005-4863 Dermatology Clinic: Prof. J. Kisis & Asst. Prof. Rone-Kupfere, Riga, Latvia Correspondence E. Salijuma, Dermatology Clinic: Prof. J. Kisis & Asst. Prof. Rone-Kupfere, Riga, Latvia. Email: [email protected]Search for more papers by this authorJ. Maskalane, J. Maskalane orcid.org/0000-0001-8340-9669 Dr. Maurins Laser Medical Clinic, Riga, LatviaSearch for more papers by this authorK. Lallas, K. Lallas Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorC. Papageorgiou, C. Papageorgiou orcid.org/0000-0003-4768-1758 Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorT. Gkentsidi, T. Gkentsidi orcid.org/0000-0003-1432-4789 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorS. M. Manoli, S. M. Manoli orcid.org/0000-0001-7450-5835 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorP. Eftychidou, P. Eftychidou First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorS. Sakellaropoulou, S. Sakellaropoulou First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorC. Nikolaidou, C. Nikolaidou Department of Histopathology, Ippokrateio General Hospital, Thessaloniki, GreeceSearch for more papers by this authorE. Vakirlis, E. Vakirlis First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorE. Sotiriou, E. Sotiriou orcid.org/0000-0001-6235-4718 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorZ. Apalla, Z. Apalla orcid.org/0000-0002-9255-8196 Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this authorA. Lallas, A. Lallas orcid.org/0000-0002-7193-0964 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, GreeceSearch for more papers by this author First published: 18 August 2023 https://doi.org/10.1111/jdv.19431 E. Salijuma and J. Maskalane contributed equally. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES 1Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin. 1985; 35(3): 130–151. 2Lallas A, Paschou E, Manoli SM, Papageorgiou C, Spyridis I, Liopyris K, et al. Dermatoscopy of melanoma according to type, anatomic site and stage. Ital J Dermatol Venerol. 2021; 156(3): 274–288. 3Welch HG, Mazer BL, Adamson AS. The rapid rise in cutaneous melanoma diagnoses. N Engl J Med. 2021; 384(1): 72–79. 4Crocetti E, Fancelli L, Caldarella A, Buzzoni C. Thickness and diameter in melanoma: is there a relation? Tumori. 2016; 102(1): e1–e3. 5Jimenez Balcells C, Hay J, Keir J, Rosendahl N, Coetzer-Botha M, Wilson T, et al. Characteristics of 637 melanomas documented by 27 general practitioners on the skin cancer audit research database. 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Background: The group of histopathologically aggressive BCC subtypes includes morpheaform, micronodular, infiltrative and metatypical BCC. Since these tumors are at increased risk of recurring, micrographically controlled surgery is considered the best therapeutic option. Although dermoscopy significantly improves the clinical recognition of BCC, scarce evidence exists on their dermoscopic criteria. Aim: To investigate the dermoscopic characteristics of histopathologically aggressive BCC subtypes. Materials and Methods: Dermoscopic images of morpheaform, micronodular, infiltrative and metatypical BCC were analyzed for the presence of predefined variables. Descriptive and analytical statistics were performed. Results: Most histopathologically aggressive BCCs were located on the head and neck. Infiltrative was the most common subtype. All subtypes, except micronodular BCC, rarely displayed dermoscopic pigmentation. The most frequent dermoscopic features of infiltrative BCC were arborizing vessels (67.1%), shiny white structures (48.6%) and ulceration (52.9%). The features prevailing in morpheaform BCC were arborizing vessels (68.4%), ulceration (n = 12, 63.2%) and white porcelain areas (47.4%). Micronodular BCC was typified by milky red structureless areas (53.8%), arborizing vessels (53.8%), short fine telangiectasias (50%), ulceration (46.2%) and blue structures (57.7%). The most common findings in metatypical BCC were arborizing vessels (77.8%), shiny white structures (66.7%), ulceration (62.9%) and keratin mass (29.6%). Limitations: Study population of only white skin and relatively small sample size in some groups. Conclusions: Our study provided data on the clinical, dermoscopic and epidemiological characteristics of histopathologically aggressive BCCs.

BACKGROUND:The histopathologic presence of basal cell carcinoma (BCC) cells at one or more margins of the specimen after surgical excision is considered suggestive of incomplete tumor clearance. The management of incompletely excised BCC might vary in different clinical scenarios from re-excision to application of other treatments or even watchful waiting.OBJECTIVE:The aims of the study were to report the real-life management of incompletely excised BCC in a tertiary referral center and compare the recurrence rates according to the selected management modality.METHODS:A retrospective study was conducted at a tertiary Dermatology Center in Northern Greece. Our electronic database was scanned over a 5-year period to retrieve all BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep). The included patients were divided into 3 groups according to the selected management after incomplete excision: group 1 included those who underwent immediate re-excision (n = 26), group 2 those who were followed up without any additional therapy (n = 40), and group 3 those who were treated with adjuvant/complementary non-surgical treatment (n = 18). Finally, we recorded the presence or absence of residual tumor in the new histopathologic report of those tumors that were selected to be re-excised (group 1). The primary outcome was the appearance of clinical tumor recurrence.RESULTS:Of 1,689 BCCs recorded in our database, 84 met the inclusion criteria and were included in the analysis. Re-excision had been selected in 26 of 84 patients (group 1), watchful waiting in 40 (group 2), and non-surgical treatments in 18 (group 3). The histopathologic reports of the 26 tumors of group 1 that were re-excised revealed residual tumor in 14 (53.8%) cases. Overall, a clinical recurrence occurred in 14 of 84 patients (16.7%) after a mean follow-up of 17 months. The median time to recurrence was 14 months. Of 40 patients without any treatment, recurrence developed in 10 (25%), while only 2 of 18 patients treated with non-surgical treatments recurred (11.1%).CONCLUSIONS:Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients. This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy.

ity of life in outpatients consulting for different dermatoses in 5 academic departments of dermatology. Eur J Dermatol 2008; 18: 412–415. 3 Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385–396. 4 Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)–a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–216.