Clinical Outcomes and Imaging in Basosquamous Carcinoma Compared with Basal and Squamous Cell Carcinomas: A Systematic Review

Abstract

Background: Basosquamous carcinoma (BSC) is a rare keratinocyte carcinoma with histological features overlapping with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It behaves aggressively, showing higher recurrence and metastatic risks, and remains difficult to diagnose and treat.

Objective: This review compared the outcomes and imaging features of BSC with those of BCC and SCC, while identifying prognostic factors and management approaches.

Methods: A systematic review under the PRISMA 2020 guidelines included studies (2010–2025) on histologically confirmed BSC, BCC, or SCC reporting outcomes or imaging findings.

Results: BSC showed recurrence rates of 4.5–14% and metastasis rates of 3–5.6%, exceeding BCC but generally lower than those of SCC. Prognostic factors included incomplete excision, perineural invasion, deep infiltration, and ear involvement. Dermoscopy and confocal microscopy revealed hybrid BCC/SCC features, while molecular studies supported BSC as a distinct entity. Wide excision and Mohs surgery were effective, and incomplete excision increased the risk of recurrence.

Conclusion: BSC is an aggressive carcinoma that lies between BCC and SCC in terms of behavior. Effective care requires margin-controlled excision, long-term surveillance, and the integration of imaging with molecular insights to aid diagnosis and guide future therapies.