Basal cell carcinoma with compromised margins: retrospective study of management, evolution, and prognosis

Abstract

Background Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations Mean follow-up time of less than five years and sample size. Conclusions The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

An Up-to-Date Correlation of Epidemiological and Histopathological Characteristics of Basal Cell Carcinoma of the Skin in a County Hospital in Romania

“…In terms of the gender distribution of the subjects, depending on the year when the patient was diagnosed with BCC, most of the male subjects were diagnosed in 2019 (39%), and most of the female participants were also diagnosed in 2019 (34%). In their research, Fidelis et al mentioned that that there was a higher incidence of BCC in men than there was in women in Brazil in 2021 [ 17 ]; this is in direct contrast with the higher incidence in men determined by Lang et al [ 18 ]. Miolo et al mentioned that that 218 BCC cases were diagnosed in people who were 66 years of age and older in their study [ 19 ].…”

Assessment of Standard Surgical Excision Efficacy and Analysis of Recurrence-Associated Factors in 343 Cases of Nasal Basal Cell Carcinoma: A Single-Center Retrospective Study

“…In our own study, which exclusively employed standard surgical excisions with serial section histology, the incidence of non-radical operations was notably lower compared to the aforementioned study (16.9%). Nevertheless, it is worth noting that scientific literature suggests that this indicator generally falls within the range of 1 to 40% worldwide [ 19 , 29 , 30 , 31 , 32 ]. To obtain a more precise estimation of the prevalence of incompletely removed tumors, we conducted a literature review.…”

“…In our research, a similar trend of statistical dependence was observed, with BCC recurrence after R1 operations being 14.5% higher, while the overall recurrence was 3.2% lower. However, in other studies, this parameter exhibits a wider range of variation (25.0-46.0%) [32]. We also explored publications with lower percentages for the analyzed criteria.…”

Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas

“…Most BCCs occur on the head and neck (i.e., regions exposed to sun), followed by the trunk and extremities (i.e., relatively unexposed). 3 , 4 Ultraviolet (UV) exposure is the most important carcinogenic factor. 1 Other risk factors include male gender, Fitzpatrick types I and II, a personal history of BCC, chronic arsenic exposure, exposure to ionizing radiation, long-term immunosuppression, genetic syndromes, and family history.…”

“… 1 Other risk factors include male gender, Fitzpatrick types I and II, a personal history of BCC, chronic arsenic exposure, exposure to ionizing radiation, long-term immunosuppression, genetic syndromes, and family history. 4 …”