How accurate is the visual assessment of basal carcinoma margins?

Epstein, Ernst

doi:10.1111/j.1365-2133.1973.tb01915.x

Cited by 102 publications

(50 citation statements)

References 6 publications

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“…Pascal et al [10] suggested that an annual visit was justified because the skin of these patients have a neoplastic potential and development of lesions at other sites may well occur. All eight patients developed further recurrences, a finding confirmed by Epstein [5].…”

Section: Discussionsupporting

confidence: 60%

Basal cell carcinoma: how long a follow-up is needed? A surgical audit

1996

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The records of 278 patients undergoing excision of basal cell carcinoma (BCC) in a calendar year were viewed. Eight were recurrent BCC. We were able to conclude that all patients with excised BCC should be followed up for at least three years. No definite correlation could be established between histologic type and recurrence. Also, histopathological adequacy of excision is no guarantee against recurrence at the same site because of the chance of spontaneous tumor cell death between clumps of tumor tissue.Basal cell carcinoma is the most common form of malignancy in human beings [1] and compromises approximately 65% of all epithelial tumors [2,11].The dilemma that arises is: (1) do these patients need to be followed up; (2) if so, for how long; (3) which of the various types is prone to recur; (4) is recurrence related to adequacy of excision?To address these questions, all BCC excised in one year were analysed. Material and methodsThe case records of patients who had BCC excised in 1993 were reviewed, this yielded 278 cases. All anatomical areas were included since one of the aims of the study was to confirm a site predilection for recurrence of BCC. The investigation included location of the primary and recurrent lesions, involvement of neighboring structures, internal between excision of primary lesion and appearance of recurrent lesion, histology of the primary and recurrent lesion and adequacy of excision margins.

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Section: Discussionsupporting

confidence: 60%

Basal cell carcinoma: how long a follow-up is needed? A surgical audit

1996

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“…1,2 However, studies have shown that only 7% of small, well-circumscribed primary BCCs infiltrate beyond 1 mm of their clinical margins. 3 Moreover, given the sensitive cosmetic and functional location of many facial tumors, taking standard 4-mm surgical margins may not be desirable. 4 Therefore, excisions with narrower margins are often performed with the surgeon determining the appropriate margin depending on the clinical situation.…”

mentioning

confidence: 99%

Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas

Kimyai‐Asadi¹,

Alam²,

Goldberg³

et al. 2005

Journal of the American Academy of Dermatology

101

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“…Studies investigating treatment safety margins of skin cancer provide recommendations ranging from 2 mm to 10 mm (21)(22)(23). We believe the use of ocular magnification and bright surgical operating room lighting play seminal roles in determining an accurate surgical margin.…”

Section: Discussionmentioning

confidence: 99%

A reliable frozen section technique for basal cell carcinomas of the head and neck

Menesi¹,

Buchel²,

Hayakawa³

2014

CAN J PLAST SURG

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Basal cell carcinoma (BCC) is the most common skin cancer worldwide and represents 75% of cutaneous malignancies (1). The mortality rate from BCCs is <1% and metastases rarely occur (0.0028% to 0.5%) (2-6). Achieving clear margins, particularly with the more aggressive histological subtypes of BCC and in recurrent tumours, can prove challenging. In these scenarios, the visible clinical margin frequently underestimates the true extent of the tumour. This phenomenon is often referred to as subclinical tumour growth with fingerlike extensions. It is particularly common in the danger zone of the face (H zone), where BCCs often behave more aggressively and recur more frequently (7,8).Before reconstruction, it is imperative that the entire BCC be removed with negative pathological margins. Incomplete resection of primary and recurrent tumours can lead to substantial morbidity and even mortality (9). The majority of BCCs can be treated using standard techniques including conventional surgical excision, curettage, cryotherapy and radiotherapy. The recurrence rates for each of these techniques has been reported to be 3% to 42% following surgical excision (10-12), 3% to 9% with curettage (13,14), 4% to 17% following cryotherapy (10) and 7% to 10% after radiation (15).Mohs micrographic surgery (MMS) or frozen section have been recommended for difficult tumours such as recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm in size (7). Cure rates with MMS has proven better than with other treatment modalities, with low overall five-year recurrence rates of 0.6% to 3% for primary BCC, and 6% to 10% for recurrent . Disadvantages of MMS include the fact that it can be very time consuming, expensive and the reconstruction may be deferred if the Mohs surgeon is not comfortable with more involved reconstructive procedures.We evaluated the effectiveness of a surgeon-directed 'en face' frozen section technique that immediately evaluates the entire peripheral and deep margins during BCC resection and potentially offers a more efficient and equally effective alternative to MMS. METHODS PatientsThe study group comprised 50 patients who were treated by a single plastic surgeon (TH) in a tertiary centre. Fifty-three BCCs were evaluated. All tumours excised from the face over a five-year period (2002 to 2006) were retrospectively reviewed. The indications for 'en face' frozen section were recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm. The 'en face' method is a technique that permits examination of the entire tumour margin (20). The sections for the 'en face' method are cut very thin to enable maximal tissue preservation. Basal cell carcinomas (BCCs) of the head and neck treated by conventional techniques of surgical excision, curettage, cryotherapy and radiation therapy have recurrence rates of up to 42%. Mohs micrographic surgery (MMS) decreases the r...

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How accurate is the visual assessment of basal carcinoma margins?

Cited by 102 publications

References 6 publications

Basal cell carcinoma: how long a follow-up is needed? A surgical audit

Basal cell carcinoma: how long a follow-up is needed? A surgical audit

Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas

A reliable frozen section technique for basal cell carcinomas of the head and neck

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