Incompletely excised basal cell carcinomas: Our guidelines

Abstract

A retrospective review of 982 patients treated for basal cell carcinoma (BCC) was conducted over a period of 8 years from 1996 to 2004. Of these patients, 16 presented a margin involvement. Two cohorts of patients with involved margin were identifi ed: the group whose basal cell carcinoma was re-excised, and the "wait and see" group. Both sets of results obtained were compared, and then matched with recent international literature reviews. Reexcision is our current practice for incompletely excised tumor. However during the period examined only 36 patients of 116 with margin involvement, proceeded to re-excision, and of the remaining 80 patients just 39 were followed-up. The others were missed mainly because of the diffi culty of attending follow-up consultations because of advanced age, poor general conditions, and unavailability of transport facilities. On the basis of several points, including a high number of residual tumors detected in the re-excised patients, and diffi culty in maintaining diligent follow-up in the "wait and see" group, we stress the importance of considering an early re-excision in case of margin involvement (focal, lateral, or deep), to avoid a signifi cant risk of recurrence. In this study 16 patients out of 39 in the "wait and see" group had recurrences over 8 years of follow-up; a signifi cant number of recurrences was observed after 5 years. We therefore reserve a clinical follow-up only for patients in whom poor general health dissuades us from re-operation.

Evaluation of surgical margins according to the histological type of basal cell carcinoma

“… 15 Other studies defend that all of the BCCs with positive surgical margins must be excised due to the difficulty in maintaining the follow-up and due to the risk of recurrence after 5 years. 16 …”

Japanese Dermatological Association guidelines: Outlines of Japanese clinical guidelines for basal cell carcinoma 2021

“…In recent years, clinical studies on resection margins have been published in Japan, although these were retrospective studies. In patients with well-defined, pigmented BCC, margins were negative in 95.3% of cases with 2-mm margins and 100% with 3-mm margins. 12 In the low-risk group, 100% of patients with 2-or 3-mm margins had negative surgical margins, and even in the high-risk group, 96.3% of patients with 3-mm margins and 88.0% with 2-mm margins had negative margins.…”

“…97 The mean follow-up period after resection of BCC was The definitions of stump proximity and non-proximity differ in each study, therefore, managing the data in a unified manner is difficult. The proximity of margins was defined as a tumor close to the margin at ×400, 94 distance from margin to tumor <1 mm, 95,98,99 <0.2 mm, 97 and <0.8 mm, 98 which are inconsistent. Meta-analyses were performed based on the definitions of adjacent and nonadjacent stumps in each study.…”

“…The histological type of the BCC was not mentioned. Longhi et al investigated the recurrence of BCC resected between 1996 and 2004 for 8 years 95 . Recurrence was observed in 0/866 of patients with non‐proximal stumps and 1/40 of patients with proximate stumps (less than 1 mm).…”

“…The histological type of the BCC was not mentioned. Longhi et al investigated the recurrence of BCC resected between 1996 and 2004 for 8 years 95.…”