2013, Number 1
Preliminary study on the use of Tzanck’s test for margin control in the surgery of well-dermarcated basad cell carcinomas
PDF size: 179.02 Kb.
ABSTRACTIntroduction: Basal cell carcinoma (BCC) is a malignant neoplasm derived from keratinocytes that originate in the basal layer of the epidermis and the follicular epithelium. The goal in the treatment of BCC is complete tumor removal, so that the probability of recurrence may be the lowest possible. Tzanck’s test has been used for margin control in the surgery of BCC and the aim of this study is to evaluate its effectiveness in mexican population.
Methods: Twenty patients with clinical and dermoscopical diagnosis of BCC were included, and confirmed by histopathology. After tumor extraction with conventional margins, the deep and lateral margins were gently scraped with a nº 15 scalpel to obtain smear materials that were spread onto microscopic slides, then dyed with giemsa stain and examined. The evaluation of Tzanck’s test effectiveness was made by comparison with the evaluation of the surgical specimen by conventional histopathology.
Results: The sensitivity and specificity of Tzanck’s test for margin control were 87.5% (CI 95% 47.4, 99.7) and 98.1% (CI 95% 89.7, 99.9), respectively. Positive and negative predictive values and the diagnostic accuracy for Tzanck’s test were 87.5% (CI 95% 47.4, 99.7), 98.1% (CI 95% 89.7, 99.9), and 96.6% (CI 95% 74.7, 99.9), respectively.
Comments: The demonstrated effectiveness of Tzanck’s test for margin control is encouraging to develop a practical alternative approach for the treatment of well-demarcated BCC.
Carucci J, Leffel D. Basal Cell Carcinoma. En: Fitzpatrick’s Dermatology in General Medicine. 7th ed. McGraw-Hill 2008, pp. 1036-1042. New York, McGraw-Hill, 2008.
Nouri K, Ballard C, Patel A, Brasie R. Basal Cell Carcinoma. En: Skin Cancer. McGraw- Hill 2008, pp. 61-85. New York, McGraw- Hill, 2008.
Peniche A. Cáncer de piel. En: Clínicas del Hospital General de México. 2007, pp. 129- 141. México D.F., Editorial Artemisa, 2007.
Rubin A, Chen E, Grande D, Ratner D. Basal Cell Carcinoma. En: Roenigk’s Dermatologic Surgery. 3rd ed. Informa Healthcare 2007, pp. 343-351. New York, Informa Healthcare, 2007.
Gross K, Steinman H. Introduction. En: Mohs surgery and histopathology. Cambridge University Press 2009, pp. 3-4. New Cork, Cambridge University Press, 2009.
Ruocco E, Brunetti G, Del Vecchio M, Ruocco V. The practical use of cytology for diagnosis in dermatology, Wiley-Blackwell, Oxford (England). J Eur Acad Dermatol Venereol 2010; 25: 125-9.
Kelly B, Shimoni T. Reintroducing the Tzanck smear, Adis International, Auckland (New Zealand). Am J Clin Dermatol 2009; 10: 141-52.
Vincenzo R, Ruocco E. Tzanck smear, an old test for the new millennium: when and how, Blackwell Science, Oxford (England). Int J Dermatol 1999; 38 (11): 830-4.
Dudgeon L, Patrick V. A new method for the rapid microscopical diagnosis of tumours: With an account of 200 cases so examined, Wiley, Chichester, West Sussex (England). Brit J Surg 1927; 58: 250-61.
Tzanck A. Le cytodiagnostic immediat en dermatologie, Masson, Paris (France). Bull Soc Fr Dermatol Syph 1947; 7: 68.
Tzanck A, Aron-Brunetikre R, Melki G: Vue d’ensemble du cytodiagnostic des tumeurs malignes épithéliales, Masson, Paris (France). Presse Méd 1950; 1: 681-3.
Vilanova X, Piñol J, Rueda L. The Cytologic Aspects of Basal Cell Carcinoma, Nature Publishing Group, New York. J Invest Dermatol 1962; 39: 123-31.
Brown CL, Klaber MR, Robertson MG. Rapid cytological diagnosis of basal cell carcinoma, BMJ Pub. Group, London (England). J Clin Pathol 1979; 32: 361-72.
Bakis S, Irwig L, Wood G, Wong D. Exfoliative cytology as a diagnostic test for basal cell carcinoma: a meta-analysis, Blackwell Scientific Publications, Oxford (England). Br J Dermatol 2004; 150: 829-36.
Vega-Memije E, Martinez-de Larios N, Waxtein LM, Dominguez-Soto L. Cytodiagnosis of cutaneous basal and squamous cell carcinoma, Blackwell Science, Oxford (England). Int J Dermatol 2000; 39: 116- 20.
Derrick EK, Smith R, Melcher DH et al. The use of cytology in the diagnosis of basal cell carcinoma, Blackwell Scientific Publications, Oxford (England). Br J Dermatol 1994; 130: 561-3.
Kimyai-Asadi A, Alam M, Goldberg LH, Peterson SR, Silapunt S, Jih MH. Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas, Mosby, Saint Louis, Missouri. J Am Acad Dermatol 2005; 53: 464-8 2005.
Caresana G, Giardini R. Dermoscopyguided surgery in basal cell carcinoma, Wiley-Blackwell, Oxford (England). J Eur Acad Dermatol Venereol 2010; 24: 1395- 9.
Baba M, Durdu M, Seçkin D. A useful alternative approach for the treatment of welldemarcated Basal cell carcinoma: surgical excision and margin control with tzanck smear test, Blackwell Science, Malden (Massachusetts). Dermatol Surg 2010; 36: 659-64.