Tumor Thickness and Determining Pathological Risk, Prognosis in BCC

Tumor thickness was associated with aggressive histological growth pattern in basal cell carcinoma (BCC), suggesting that the assessment of tumor thickness may help in determining the pathological risk and prognosis in patients with BCC, according to research findings published in the Journal of Cosmetic Dermatology.

The study was a retrospective review of 85 primary BCCs in 82 patients who underwent surgery at a single center from 2002 to 2008. In total, 91.7% of the tumor slides were available for retrospective review. Researchers evaluated the histological subtype, ulceration, perineural invasion, and tumor thickness. The study looked for “aggressive growth patterns,” which were defined as tumors that demonstrated infiltrative, micronodular, morpheaform, and basosquamous features.

Mean diameter of the evaluated tumors was 0.94±0.48 cm. The investigators identified 3 histopathological subtypes in 6.4% tumors. Approximately 42.3% of the tumors contained 2 histopathological subtypes, while 51.2% of the tumors had 1 subtype.

The dominant histopathological subtype was nodular (60%), superficial (11.8%), infiltrative (9.4%), micronodular (5.9%), keratotic (3.5%), and basosquamous (1.2%). Nearly 45% of the tumors had ulceration. In addition, the investigators observed perineural invasion in 2.6% tumors, including 1 with infiltrative and 1 with basosquamous features.

In the 78 tumors, the mean tumor thickness was 1.88±0.84 mm. An aggressive growth pattern was identified in 26.9% of the tumors, with a mean tumor thickness measuring 2.19±0.71 mm. In contrast, 73% of the tumors had nonaggressive growth pattern, with a mean tumor thickness in 56 of these tumors measuring 1.76±0.87 mm.

According to the investigators, there was a significant difference in the mean tumor thickness between tumors featuring an aggressive growth pattern vs a nonaggressive growth pattern (P =.033), with tumors featuring an aggressive growth pattern noted as thicker than those with a nonaggressive growth pattern.

Although “tumor thickness is not yet considered as a criterion for risk identification in BCC,” the researchers wrote that “measuring and reporting tumor thickness may be a more practical way to determine the pathological risk for BCC and may provide a better guide for the clinician to decide among treatment options.”


Gülseren D, Elçin G, Erkin G, Gököz Ö. The correlation between tumor thickness and aggressive histopathological pattern in Basal cell carcinoma. J Cosmet Dermatol. 2021;00:1–4. doi:10.1111/jocd.14475