Clinical and Pathological Findings in Reexcision of Incompletely Excised Basal Cell Carcinomas

Abstract

In common practice, patients with incompletely excised basal cell carcinomas (BCCs) are referred to elective reexcision. In previous reports, it was observed that tumor cells are found in only 50% of the reexcised specimens. The authors performed a retrospective analysis of a large series of patients to evaluate clinical and pathological findings in patients who underwent reexcision of incompletely excised BCCs. A total of 1,478 BCCs arising in 1,278 patients were excised by plastic surgeons in a plastic and reconstructive surgery department during a 4-year period. In 159 patients (10.8%), the excision was incomplete according to the pathological report. These tumors were defined as an incompletely excised BCCs. One hundred of the 159 patients with incompletely excised BCCs (62.9%) were reoperated. Residual tumor cells were found in 28 of 100 patients (28%) within the pathological specimen of the reexcised tissue (defined as positive reexcision, or +veRE). There was no correlation between +veRE and the age or sex of the patient. Location of the BCCs in the cheeks, eyelids, or ears was associated with a low percent of +veRE (10.0%, 13.3%, and 22.2% respectively). Pathological factors associated with a low percent of +veRE were dermal inflammatory infiltrate in the pathological specimen (p = 0.003) and sun damage pathological changes (p = 0.03), but there was no correlation with the pathological subtype distribution of the tumors. The authors conclude that lack of tumor cells at reexcision of incompletely excised BCCs is associated with location of the tumors in the cheeks, eyelids, and ears, and with pathological findings of dermal inflammatory infiltrates or sun damage changes. The roles of inflammatory and solar changes in the destruction of residual carcinoma cells should be investigated further.

Incomplete excision of basal cell carcinoma in the subunits of the nose

“…Residual tumour was found in only just over half the specimens excised further. This number is virtually identical to that reported by Griffiths [1], whereas other series reported even lower values of about 30% [7,10]. Although the other reports were not specific for BCC of the nose, these findings raise the question of the therapeutic attitude in such cases.…”

Risk factors for incomplete excision of squamous cell carcinomas

“…In previous studies we have described risk factors associated with incomplete excision of basal cell carcinomas (5,6). Our results were among several other publications that described incomplete excision of basal cell carcinomas (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22); however, only a few studies were published on risk factors that may play a role in incomplete excision of SCCs (1)(2)(3)(4).…”

“…In the past, most of the studies of surgical clearance rate pertained to basal cell carcinomas, with surgical failure rates between 4% and 16% (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Only a few studies reported on surgical failure rates in SCCs that range between 0% and 16% (1-4).…”

Incomplete Excision of Basal Cell Carcinoma: A Prospective Trial

“…The chin (20 percent), periorbital (17.9 percent) and periauricular regions (17 percent), and forehead and tem- 12,19,23 The percentage of incomplete excision for morpheic basal cell carcinomas was significantly higher than all other subtypes. This finding has been confirmed in several studies.…”