# High-Frequency Ultrasound Assessment of Basal Cell Carcinoma: Correlations Between Histopathological Subtype, Vascularity, and Age/Sex Distribution

## TL;DR

High-frequency ultrasound helps distinguish aggressive and non-aggressive skin cancer types by analyzing tumor shape and blood flow.

## Contribution

HFUS reliably differentiates solid and infiltrative basal cell carcinoma subtypes based on ultrasound contour and vascularity.

## Key findings

- Solid BCCs showed well-defined margins and hypervascularity, while infiltrative BCCs had irregular contours and reduced vascularity.
- HFUS detected seven recurrences post-surgery, supporting its role in follow-up.
- Ultrasound features strongly correlated with histopathological subtypes (p < 0.001).

## Abstract

Basal cell carcinoma is the most common type of skin cancer and usually grows slowly, but some forms can behave more aggressively. High-frequency ultrasound (HFUS) is a non-invasive imaging method that supports the preoperative evaluation of basal cell carcinoma. In this study, ultrasound contour and vascularity patterns showed a strong association with histological subtype, enabling reliable differentiation between solid and infiltrative tumours. Solid lesions were typically well-defined and hypervascular, whereas infiltrative tumours more often showed irregular margins and reduced vascularity. HFUS therefore represents a valuable adjunct to dermatoscopy for treatment planning and postoperative follow-up.

Background: High-frequency ultrasound (HFUS) has emerged as a valuable non-invasive imaging modality for the preoperative assessment of basal cell carcinoma (BCC). However, its ability to reliably differentiate between histopathological subtypes based on morphological and vascular characteristics requires further validation. Methods: Between January 2010 and December 2011, 320 patients with a total of 330 histologically confirmed BCC lesions were examined using HFUS (15–18 MHz linear transducer). Lesions were classified according to ultrasound contour (sharp vs. irregular) and vascularity (hypervascular vs. hypovascular) and correlated with histopathological subtype (solid vs. infiltrative). Postoperative ultrasound follow-up was performed in a subset of patients for recurrence detection. Results: Solid BCCs were predominantly characterised by sharp, well-defined margins, whereas infiltrative tumours more frequently exhibited irregular contours. This association was highly significant (χ2 = 24.7, df = 1, p < 0.001; OR = 71.9, 95% CI: 37.0–139.8). Vascularity patterns also differed significantly between subtypes: solid tumours were more likely to present with hypervascular features, while infiltrative tumours more frequently exhibited hypovascular patterns (χ2 = 23.8, df = 1, p < 0.001; OR = 3.24). No statistically significant associations were observed between ultrasound morphology and patient sex or age. Among patients who participated in postoperative HFUS follow-up, seven histologically confirmed recurrences were detected. Conclusions: HFUS provides reliable preoperative information on BCC morphology and vascularity, enabling accurate differentiation between solid and infiltrative subtypes. These findings support the role of HFUS as a valuable adjunct to dermatoscopy in treatment planning and postoperative surveillance of BCC.