Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

Girardi, Fábio Muradás; Wagner, Vivian Petersen; Martins, Manoela Domingues; Abentroth, Aliende Lengler; Hauth, Luiz Alberto

doi:10.1016/j.bjorl.2020.02.007

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…They also showed that the Clark level and the depth of invasion (Breslow index) were independent risk factors for insufficiently safe margins. Thus, in their study, tumors with inadequate margins had a Clark level of 4 to 5, and the median of Breslow index was at 2, similar to our results ( 19 ).…”

Section: Discussionsupporting

confidence: 89%

Predictive factors for the recurrence of surgically excised basal cell carcinomas: A retrospective clinical and immunopathological pilot study

Vornicescu

Şenilă

Bejinariu³

et al. 2021

Exp Ther Med

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Basal cell carcinoma (BCC) is the most frequent form of skin cancer and is not a tumor with a lethal outcome if diagnosed and treated adequately. The gold standard for treatment is surgical excision with histologically safe margins. Even so, tumors excised with free margins may recur after a period of time. The identification of predictive factors for the recurrence of BCCs besides the localization, size and aggressive histology may be useful for the clinician. The aim of the present study was to identify clinical and pathological factors associated with recurrence in tumors with histologically free margins and assess via immunohistochemical staining, the expression of glioma-associated oncogene homolog 1 (GLI1), yes-associated protein (YAP), connective tissue growth factor (CTGF) and E-cadherin as they are involved in the development of BCCs, in the hope of identifying markers that are predictive for recurrence. In total, 8 recurrent BCCs and 38 non-recurrent tumors were analyzed. A Breslow index >2 (Se 100.0%, Sp 67.5%, P=0.008), Clark level >3 (Se 100.0%, Sp 47.5%, P<0.001), and excision margins both lateral (Se 87.5%, Sp 60.0%, P=0.04) and deep (Se 75.0%, Sp 82.5%, P<0.001) free from tumoral cells ≤1 mm proved to be predictive for recurrence in the present study. Recurrence may appear even after more than 3 years since the initial excision (Se 87.50%, Sp 70.0%, P<0.001). The expression levels of GLI1, YAP and E-cadherin were not different in the recurrent vs. non-recurrent BCCs. However, the low expression of CTGF may indicate a tumor with a higher aggressiveness. In conclusion, close follow-up of patients with excised BCCs at least annually is recommended and re-excision should be taken into consideration for locally advanced tumors especially if they are located in high-risk areas or those with histologically free margins <1 mm.

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Section: Discussionsupporting

confidence: 89%

Predictive factors for the recurrence of surgically excised basal cell carcinomas: A retrospective clinical and immunopathological pilot study

Vornicescu

Şenilă

Bejinariu³

et al. 2021

Exp Ther Med

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“…17 In the study by Girardi et al, 18 the most common subtypes were nodular and basosquamous forms, and the positive surgical margin was significantly higher in the aggressive forms. 18 In the present study, the most common subtype was the nodular form (46.3%), followed by the nodular-micronodular type (24.2%); the superficial type was the least common subtype (4.2%). Unlike the literature, the positive surgical margin was found at the highest rate (54.5%) in mixed forms.…”

Section: Discussionmentioning

confidence: 94%

Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?

Torun,

Yılmaz

2024

Adv Skin Wound Care

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OBJECTIVE To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs. METHODS Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes. RESULTS Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001). CONCLUSIONS Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.

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“…Incisional biopsy is recommended before surgery for a better diagnosis and a histopathological analysis is necessary later to verify the pathological specimen, as the cutaneous recurrence of basal cell carcinoma is associated with inadequate surgical margins. As a histological pattern, basal cell carcinoma presents itself as a proliferation of nests and strands of small to medium-sized basaloid cells with peripheral palisade of nuclei [6,7,10]. The incisional biopsy was performed to confirm the patient's diagnosis and after the total resection of the lesion, the margins were considered free of the lesion, and after one year of postoperative the patient didn't show clinical signs of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The resection margins of the lesion in a pathological analysis are classified as free, compromised or limited, by the following criteria: free margins -limit of resection without any contact with neoplastic cells; compromised margins -presence of neoplastic cells in one or more analysed specimen margins; exiguous margins -resection limit close to localization of neoplastic cells [10].…”

Section: Introductionmentioning

confidence: 99%

Autograft reconstruction of nasal dorsum in cutaneous neoplasia treatment

Aguiar

Pinheiro

Melo³

et al. 2022

RGO, Rev. Gaúch. Odontol.

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Basal cell carcinoma is the most common type among skin cancers. It occurs in basal cells and is primarily caused by sun exposure. It mainly affects elderly people, mainly man, in exposed areas of the body and is diagnosed through biopsy. The choice of treatment depends on the type, size, location and depth of penetration, the patient’s age, health conditions and potential aesthetic outcome. The present study aims to evidence, through a case report, the aesthetic and functional importance of the cutaneous transplant technique in cases of tissue loss in the face region by Basal cell carcinoma. A 56-year-old female patient, leukoderma, attended the Maxillofacial Surgery and Traumatology service of the Federal University of Pernambuco, complaining of asymmetry in the nasal dorsum region, with differentiated staining and raised edges. In anamnesis time she reported having suffered sun exposure for long periods. The patient underwent an incisional biopsy and subsequently, with a diagnosis of basal cell carcinoma, a resection of the lesion followed by skin autografting. Good acceptances of the skin flap as well as excellent aesthetic result were attained. The autogenous grafts use has shown satisfactory aesthetic results for remaining coverage after the lesion excision.

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Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

Cited by 8 publications

References 23 publications

Predictive factors for the recurrence of surgically excised basal cell carcinomas: A retrospective clinical and immunopathological pilot study

Predictive factors for the recurrence of surgically excised basal cell carcinomas: A retrospective clinical and immunopathological pilot study

Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?

Autograft reconstruction of nasal dorsum in cutaneous neoplasia treatment

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