Recurrence rate of basal cell carcinoma with positive histopathological margins and related risk factors

Abstract

BACKGROUNDThe best way to approach surgically removed basal cell carcinoma with positive histopathological margins is a controversial issue. Some authors believe that the more appropriate treatment is an immediate reoperation while others prefer a periodic follow up. The rates of recurrence are variable in literature, between 10% and 67%.OBJECTIVETo define the recurrence rate of basal cell carcinoma with positive margins after surgery. Secondarily, identify morphological aspects that can suggest a more frequent tumoral recurrence.METHODSThis was a retrospective and observational study made by analysis of medical records of 487 patients between January 2003 and December 2009 in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). From 402 basal cell carcinomas surgically treated, 41 fulfilled inclusion criteria and were evaluated for five years or more. Recurrence rate of these tumors was analyzed in all patients and clinical characteristics such as sex, age, tumor size, tumor site, ulceration, and histological type were evaluated in order to find if they were related to more common tumoral recurrence.RESULTSThe rate of positive margins after surgery was 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group. Tumor size, site, histological type, ulceration and type of positive margin did not differ statistically between groups. It was not possible to consider if these factors were important in recurrence rates.STUDY LIMITATIONSIdeally, a prospective study with a larger sample would be more accurate.CONCLUSIONThe treatment of choice in basal cell carcinoma with positive margins must be individualized to reduce recurrence rates.

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

“…2 The present study showed a predominance of lesions in the cephalic segment (p <0.05), the most common site of BCC according to the literature, in view of the greater exposure and cumulative effect of solar rays. [1][2][3][5][6][7][8][9][10] The nodular histopathological type predominated in the study (85 lesions, 73.28%), in accordance with other studies. 2,8 The micronodular and sclerodermiform subtypes considered as aggressive forms 8,11,12 accounted for 20 lesions (17.24%), and were associated to recurrences (p <0.05).…”

“…[1][2][3][5][6][7][8][9][10] The nodular histopathological type predominated in the study (85 lesions, 73.28%), in accordance with other studies. 2,8 The micronodular and sclerodermiform subtypes considered as aggressive forms 8,11,12 accounted for 20 lesions (17.24%), and were associated to recurrences (p <0.05). The nasal region, site of the 3 relapses in the study (p <0.05, Fisher's Exact Test), is cited in the literature as a risk factor, considering the difficulty of surgical margins due to local anatomy, or concern about the aesthetic outcome.…”

“…4 In the literature, recurrences of these tumors range from 4% to 16.6%, but do not separate between the cases with recurrence by primary closure from those requiring more complex reconstructions. [5][6][7][8][9][10] Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts *…”

The role of radiotherapy in the management of non‐melanoma skin cancer

“…deep nasolabial fold recurrence). Not all patients with positive margins will eventually develop local recurrence with the literature suggesting a recurrence rate of incompletely excised BCC's of up to 30–40% . It is however difficult to determine an individual's risk of recurrence without further treatment, and in many cases simple re‐excision is not always an option (e.g.…”

Common dermatology questions and answers about the radiation treatment of skin cancer in the modern era

“…Once again recent data is of inferior quality. Lara et al 34 report that in a single institution retrospective study made up of 487 patients treated with surgery alone for cSCC, there was a rate of positive margins after surgery of 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group.…”