Basal cell carcinoma margin delineation: is curettage useful? A surgical and histological study

Abstract

Basal cell carcinoma (BCC) is the most common variety of non-melanoma skin cancer. Treatment modalities include cryotherapy, topical imiquimod 5% cream, photodynamic therapy, electrodessication and curettage, classic surgical excision, Mohs surgery, and radiotherapy. Surgical treatments are regarded as the most effective, but, in some cases, may produce poor cosmetic outcomes. Delineating tumor margins as much as possible is important in order to limit broad surgical excisions. Preoperative curettage is a surgical technique proposed to delineate BCC margins. Reported data on curettage utility are controversial. Some authors report that curettage better delineates the tumor, decreasing relapsing rates, whereas others consider it as a nonspecific procedure that may damage the surrounding healthy tissue and falsely increase the final defect size. We studied the pathologic features of curetted material and the main surgical specimens of 55 BCC treated with preoperative curettage. According to BCC subtype, preoperative curettage may lead to a complete or almost complete tumor removal. Preoperative curettage might be helpful in delineating BCC margins, especially in nodular and superficial BCC. No evidence of unspecific removal of tumor's surrounding healthy tissue was observed in our specimens.

Skin biopsy

“…Superficial and nodular basal cell carcinomas (BCCs) are best suited to defining tumor extent via curettage, whereas infiltrative, morpheaform, and micronodular BCCs are surrounded by dense collagen, and the extent of the tumor cannot be defined by curettage of tumor and stroma. 44,45 The same is true for desmoplastic squamous carcinoma and for tumors with perineural invasion, which may extend far beyond the clinically evident tumor margins.…”

Photodynamic therapy for skin cancer: How to enhance drug penetration?

“…To minimize the possibility of recurrences, the practician needs to remove 5 mm of the surrounding tissue with normal appearance [125]. This technique has been recommended for skin preparation since it delineates well the tumour [126], it is effective, acceptable, and quite inexpensive [127]. This gentle removal is often used for superficial basal cell carcinoma (sBCC) treatment and consists of scraping crust and scale [128].…”

“…Curettage increased PpIX fluorescence [129] and according to [130] MAL-PDT with prior curettage was a promising method for the treatment of BCC with a clearance rate of 91% for sBCC (131 lesions treated), 93% for thin nBCC (82 lesions) and 86% for thick nBCC (86 lesions treated). Cosmetic out comes were excellent (i.e lesion area not visible) and recurrence rate after ALA-PDT with prior curettage was low which make it a good skin pretreatment method [126,130]. Nevertheless some authors report that curettage may damage surrounding healthy tissue and cause pain for patients [126,129].…”

“…Cosmetic out comes were excellent (i.e lesion area not visible) and recurrence rate after ALA-PDT with prior curettage was low which make it a good skin pretreatment method [126,130]. Nevertheless some authors report that curettage may damage surrounding healthy tissue and cause pain for patients [126,129].…”

High-Risk Recurrence Basal Cell Carcinoma: Focus on Hedgehog Pathway Inhibitors and Review of the Literature

“…It derives from the cells of the epidermal basal layer either interfollicular or of the hair follicle [1]. For the vast majority of the neoplasms, surgical excision with free margins is both diagnostic and therapeutic [2]. For a very small proportion of patients, with higher risk of recurrence, the preferred surgical technique is Mohs micrographic surgery [3-6].…”