Key characteristics of basal cell carcinoma with large subclinical extension

Abstract

Background Basal cell carcinoma with large subclinical extension (BCC‐LSE) is a tumour whose extensive spread becomes apparent during Mohs surgery histopathology review. Not recognizing BCC‐LSE preoperatively may result in a greater number of Mohs layers and in larger than anticipated postoperative defects. Objective To evaluate the characteristics of BCC‐LSE. Methods This retrospective study reviewed BCC treated with Mohs surgery at a single academic surgical centre between March 2007 and February 2012. A total of 2044 cases met the criteria of BCC‐LSE, which was defined as a lesion requiring at least three Mohs stages and a final surgical margin (difference between preoperative and postoperative measurements in either vertical or horizontal dimensions) of ≥1 cm. Results In adjusted multivariable analysis, male sex (P = 0.05), Fitzpatrick skin type I (P = 0.002), history of prior BCC (P = 0.003) and subtypes of basosquamous, metatypical, micronodular, infiltrative, morpheaform and sclerosing (P = 0.005) remained significant BCC‐LSE predictors. Conclusions Demographic factors, including personal history of BCC, skin type, anatomic location, gender and age, in addition to tumour histologic subtype assessed through incisional biopsy, can help predict occurrence of BCC‐LSE and assist physicians in optimizing preoperative assessment of surgical time and complexity.

Mohs Micrographic Surgery for Basal Cell Carcinoma: Predictive Factors for Increased Stages and Relative Defect Sizes

“…In our cohort, BCC removed from high‐risk areas of the head and neck, such as the ear, eye, eyebrow and nose, required more stages during MMS compared to those located on the cheek, chin, forehead, lip, neck and scalp. These findings are consistent with those of other studies [10, 23]. Achieving clear surgical margins in these sensitive regions must be carefully balanced against preserving both aesthetic appearance and essential function.…”

“…We observed a linear correlation between increasing age and both the number of MMS stages and relative defect sizes for head and neck BCC, consistent with findings from multiple international studies [7,10,11]. This trend may be influenced by several factors: younger patients generally present with smaller, more defined tumours, while older patients, often with photodamaged skin, tend to have less distinct tumour margins, requiring additional surgical stages [12,13].…”

Mohs Micrographic Surgery for Basal Cell Carcinoma: Predictive Factors for Increased Stages and Relative Defect Sizes

“…In our cohort, BCC removed from high‐risk areas of the head and neck, such as the ear, eye, eyebrow and nose, required more stages during MMS compared to those located on the cheek, chin, forehead, lip, neck and scalp. These findings are consistent with those of other studies [10, 23]. Achieving clear surgical margins in these sensitive regions must be carefully balanced against preserving both aesthetic appearance and essential function.…”

“…We observed a linear correlation between increasing age and both the number of MMS stages and relative defect sizes for head and neck BCC, consistent with findings from multiple international studies [7,10,11]. This trend may be influenced by several factors: younger patients generally present with smaller, more defined tumours, while older patients, often with photodamaged skin, tend to have less distinct tumour margins, requiring additional surgical stages [12,13].…”

Mohs Micrographic Surgery in the Australian Public Health System: A Retrospective Observational Study and Review of the Australian Literature

“…finding only seen once before in the Australian MMS literature ( [18]), and most likely due to referral bias. Despite having similar tumour sizes, males in our study had larger defects, which has also been reported previously in international studies [20,28]. This pattern has been associated with male sex being a significant risk factor for more subclinical tumour spread [19,28].…”

Clinicopathological factors influencing the number of stages of Mohs surgery for basal cell carcinoma

“…Regarding high-risk location, there is a statistically significant difference in a number of stages between tumors located in the periocular region and tumors of the ear, nose, or perioral area, with periocular BCCs requiring more stages of surgery. Although location on high-risk areas was shown to be associated with a higher number of stages in previous studies, 4 , 5 , 7 the specification and comparison between various high-risk areas are more rarely mentioned in the literature.…”

Mohs Micrographic Surgery for Basal Cell Carcinoma: Predictive Factors for Increased Stages and Relative Defect Sizes

“…In our cohort, BCC removed from high‐risk areas of the head and neck, such as the ear, eye, eyebrow and nose, required more stages during MMS compared to those located on the cheek, chin, forehead, lip, neck and scalp. These findings are consistent with those of other studies [10, 23]. Achieving clear surgical margins in these sensitive regions must be carefully balanced against preserving both aesthetic appearance and essential function.…”

“…We observed a linear correlation between increasing age and both the number of MMS stages and relative defect sizes for head and neck BCC, consistent with findings from multiple international studies [7,10,11]. This trend may be influenced by several factors: younger patients generally present with smaller, more defined tumours, while older patients, often with photodamaged skin, tend to have less distinct tumour margins, requiring additional surgical stages [12,13].…”

Mohs Micrographic Surgery in the Australian Public Health System: A Retrospective Observational Study and Review of the Australian Literature

“…finding only seen once before in the Australian MMS literature ( [18]), and most likely due to referral bias. Despite having similar tumour sizes, males in our study had larger defects, which has also been reported previously in international studies [20,28]. This pattern has been associated with male sex being a significant risk factor for more subclinical tumour spread [19,28].…”

Clinicopathological factors influencing the number of stages of Mohs surgery for basal cell carcinoma

“…Regarding high-risk location, there is a statistically significant difference in a number of stages between tumors located in the periocular region and tumors of the ear, nose, or perioral area, with periocular BCCs requiring more stages of surgery. Although location on high-risk areas was shown to be associated with a higher number of stages in previous studies, 4 , 5 , 7 the specification and comparison between various high-risk areas are more rarely mentioned in the literature.…”

Mohs Micrographic Surgery for Basal Cell Carcinoma: Predictive Factors for Increased Stages and Relative Defect Sizes

“…In our cohort, BCC removed from high‐risk areas of the head and neck, such as the ear, eye, eyebrow and nose, required more stages during MMS compared to those located on the cheek, chin, forehead, lip, neck and scalp. These findings are consistent with those of other studies [10, 23]. Achieving clear surgical margins in these sensitive regions must be carefully balanced against preserving both aesthetic appearance and essential function.…”

“…We observed a linear correlation between increasing age and both the number of MMS stages and relative defect sizes for head and neck BCC, consistent with findings from multiple international studies [7,10,11]. This trend may be influenced by several factors: younger patients generally present with smaller, more defined tumours, while older patients, often with photodamaged skin, tend to have less distinct tumour margins, requiring additional surgical stages [12,13].…”

Mohs Micrographic Surgery in the Australian Public Health System: A Retrospective Observational Study and Review of the Australian Literature

“…finding only seen once before in the Australian MMS literature ( [18]), and most likely due to referral bias. Despite having similar tumour sizes, males in our study had larger defects, which has also been reported previously in international studies [20,28]. This pattern has been associated with male sex being a significant risk factor for more subclinical tumour spread [19,28].…”

Clinicopathological factors influencing the number of stages of Mohs surgery for basal cell carcinoma

“…Regarding high-risk location, there is a statistically significant difference in a number of stages between tumors located in the periocular region and tumors of the ear, nose, or perioral area, with periocular BCCs requiring more stages of surgery. Although location on high-risk areas was shown to be associated with a higher number of stages in previous studies, 4 , 5 , 7 the specification and comparison between various high-risk areas are more rarely mentioned in the literature.…”