A retrospective analysis of 137 head and neck keratinocyte cancer excisions and their pre-operative biopsy correlation in a regional Australian otolaryngology centre

ObjectiveKeratinocyte cancers (KCs) account for significant healthcare burden in regional Australia. Effective surgical management relies on accurate pre-operative biopsy to inform risk status and guide clinical excision margins. Through retrospective analysis, we aim to describe correlation rates of pre-operative biopsy and final pathology in head and neck KC excisions.MethodsFrom July 2023 to June 2024, 137 KC excisions performed in a regional Australian Otolaryngology Head and Neck surgery outpatient skin unit were analysed. Patient demographics, lesion characteristics, preoperative biopsy, and final histopathology were examined.ResultsExcisions were undertaken for 101 basal cell carcinomas (BCCs), 30 squamous cell carcinomas (SCCs), and six intra-epidermal carcinomas. Nineteen excisions were performed without pre-operative biopsy and 15 further excisions were re-excisions for close or involved margins and were not included in correlation analysis. Of the remaining 97 KC, there was concordance between biopsy and formal pathology risk status in 47.4%. Upgraded (higher) risk formal pathology was reported in 19.6% while downgraded (lower) risk formal pathology was reported in 8.2%. Within the higher risk group, three BCC excisions reported close margins when their lower risk subtype (if confirmed) would have been considered clear. There was no residual malignancy in 24.7% of KC excisions. Pathologic concordance rates after subgroup analysis were 58.7% for BCCs and 9.1% for SCCs.ConclusionAccurate pre-operative biopsy to guide treatment options and inform clinical margins is especially important for head and neck KCs, where functional and cosmetic constraints are greatest. The correlation rate for surgically excised head and neck KCs has not been previously investigated in the Australian regional setting. This work highlights the importance of counselling patients on the potential for higher risk final pathology when discussing the risk of requiring further treatment.