High-frequency ultrasound in dermatological oncology: evidence-based value for planning and selecting treatment strategy in patients with basal cell carcinoma

Objective — to determine the effectiveness of high-frequency ultrasound (HFUS) for preoperative assessment and visualization of basal cell carcinoma (BCC) in order to select the method and extent of surgical intervention based on HFUS results. Materials and methods. From 2022 to 2024, 89 patients with a preliminary clinical diagnosis of BCC were examined at the Bogomolets Institute of Dermatology and Cosmetology: 63 women (70.8 %) and 26 men (29.2 %); average age 52.5 years (range 21—84 years). Based on the results of our own clinical observations, dermatoscopic, high-frequency ultrasound, and histopathological studies, we evaluated the impact of preoperative diagnosis on the choice of surgical strategy. Results and discussion. According to ultrasound data and taking into account the localization of the process, F.E. Mohs micrographic surgery (MMS) was performed in 46 (51.7 %) patients. The selection was based on H/M/L zoning and clinical and visual risk factors according to the Appropriate Use Criteria (AUC), 2012 [4], using high-frequency ultrasound for precise preoperative mapping [27]. This approach was associated with a reduction in the need for intraoperative re-excision of peripheral and deep margins in critical areas and, accordingly, a reduction in the duration of the intervention. In the Mohs cohort, the median number of stages was 1 (IQR 1—2; range 1—2): 38 (82.6 %) cases — removal in 1 stage without additional stages; 8 (17.4 %) — required 1 additional stage; ≥ 3 stages were not observed. Among 26 patients (29.2 %), the dermatoscopic margins did not coincide with the HFUS-defined margins. Taking into account the ultrasound data and international recommendations, 14 out of 26 (53.8 %) cases underwent single-stage excision with «clear» margins according to histopathology, and in 12/26 (46.2 %) — Mohs surgery was performed without additional stages, which accelerated the operation and improved the postoperative course. Conclusions. High-frequency ultrasound can be integrated into the Mohs surgery planning algorithm, taking into account the H/M/L zones and dermatoscopy, is associated with a reduction in intraoperative stages, a reduction in the duration of the intervention, and a reduced reconstructive burden. In our cohort, 82.6 % of tumors were removed in 1 stage of Mohs surgery, 17.4 % in 2 stages; there were no cases with ≥ 3 stages. Ultrasound also helps to refine preoperative margin planning: discrepancies between dermatoscopy and ultrasound margins were found in 29.2 % of cases and influenced the choice of single-stage excision or Mohs without additional excisions. The data obtained indicate the feasibility of routine use of high-frequency ultrasound in planning and selecting the method of surgical intervention for BCC and justify the need for further research to standardize protocols.