A retrospective study of 694 Basal Cell Carcinoma excisions to quantify deep margin documentation and clearance compared to histological type and surgical margin

Kiely, John; Patel, Animesh

doi:10.1016/j.bjps.2019.06.002

Cited by 19 publications

(7 citation statements)

References 27 publications

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“…Pigmented lesions were found in 55% of the cases of BCC [38]. Pigmented BCC is commonly found in the Asian population and patients with darker skin color [54][55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Kadir¹,

Mitra

Rashid³

et al. 2022

Journal of Skin Cancer

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Background. Eyelid tumours are common in our ophthalmic practice. Malignancy cases account only for one-fourth of all eyelid tumours. The most aggressive eyelid malignancy is sebaceous gland carcinoma, but its occurrences are rare in western countries. We found sebaceous gland carcinoma is as common as basal cell carcinoma in our clinical practices. Hence, it is essential to build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality. Aim. To assess the relative frequency of eyelid malignancies in the Bangladesh population, state their clinical features and outcome of management strategies and build awareness about the more aggressive eyelid malignancies to reduce morbidity and mortality. Methods. This was a retrospective case series study of 332 patients in Bangladesh. This study analyzed all the recorded data of the histologically proven primary eyelid malignancies and followed them up for at least six months from 2014 to 2019 (6 years). All patients were managed by surgical excision with tumor-free margins verified on histopathology, either the frozen section or excision biopsy with 2–3 mm microscopic view of normal tissue followed by eyelid reconstruction. Computer-based statistical software SPSS was used for the analysis, and an appropriate test of significance (chi-square) was used for the statistical analysis. Results. Sebaceous gland carcinoma (SGC) was the highest in occurrence, at 42%, followed by 38% basal cell carcinoma (BCC), 18% squamous cell carcinoma (SqCC), and 02% malignant melanoma (MM). The mean age at presentation of SGC, BCC, SqCC, and MM were 57.41 years, 62.56 years, 64.73 years, and 59.28 years, respectively. Female (59%) was slightly more preponderance over the male (41%) for SGC than other malignancies. Pigmentation was associated with malignant melanoma (100%) and BCC (81%). Statistically, a significant difference was found between eyelid malignancies, including location, size, pigmentation, recurrence, and invasiveness. The recurrence rate was low lower in the patients who underwent frozen section biopsy (3%) for margin clearance than those who underwent excision biopsy (21.5%) in the follow-up time. Conjunctival map biopsy (8%) was performed as an essential tool for excluding the pagetoid spread of SGC. A new reconstruction method named triangular-shaped musculocutaneous tail flap was performed in 33 (11%) patients to reconstruct the moderate eyelid defect following local resection. Conclusion. Sebaceous gland carcinoma (SGC) was the highest occurrence found to be the highest occurrence among all eyelid malignancies in Bangladesh. SGC is more aggressive and the recurrence rate was higher than BCC and SqCC.

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“…Pigmented lesions were found in 55% of the cases of BCC [38]. Pigmented BCC is commonly found in the Asian population and patients with darker skin color [54][55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Kadir¹,

Mitra

Rashid³

et al. 2022

Journal of Skin Cancer

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“…BCC invasive metastases are accompanied by changes in the stromal component of the lesion margins, which can be detected visually when they occur in the epidermis or superficial dermis, but such changes are not limited to the epidermis or superficial dermis, especially for BCC with a large depth of infiltration 7 . In this context, the method of delineating the tumor boundaries visually and then adding a certain width of soft tissue to design the surgical margins has been accepted by most scholars 8 .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas

Liang

Feng

Wang

et al. 2022

J of Ultrasound Medicine

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Objectives-The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM).Methods-10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups.Results-The elasticity ratio (E ratio ) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P = .000), while other parameters show no difference. The E ratio of RTB and OSM were 1.22 AE 0.14 and 0.99 AE 0.07. The area under the ROC curve was .947. Taking 1.075 as the threshold of E ratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB + 5 mm (P = .000).Conclusions-The E ratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing.

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“…26 Various guidelines exist for the surgical management of BCC; however, the varied distribution of histologic subtypes led to alternative approaches based on individual patient factors. 27 Histologically, low-risk lesions present with nodular or superficial growth patterns, whereas high-risk lesions demonstrate aggressive growth patterns, including basosquamous, sclerosing, mixed infiltrative, or micronodular features in any portion of the tumor. 28 Of all included cases, the majority (n = 58, 81.7%) demonstrated aggressive features on histopathology.…”

Section: Discussionmentioning

confidence: 99%

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16‐Year Institutional Experience

et al. 2020

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Objective To report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma. Study Design Retrospective chart review. Setting Tertiary academic center. Methods Retrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics. Results The median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction. Conclusion Periauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.

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A retrospective study of 694 Basal Cell Carcinoma excisions to quantify deep margin documentation and clearance compared to histological type and surgical margin

Cited by 19 publications

References 27 publications

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases

Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16‐Year Institutional Experience

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