Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma

BACKGROUNDsquamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases. OBJECTIVEThe objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis. METHODSA retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.RESULTSSixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins. CONCLUSIONSMost patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.

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“…3 Another study found that 50% of SCC lesions with positive margins recurred with consequent increased risk of developing metastases. 22 …”

Section: Discussionmentioning

confidence: 99%

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis

Vasconcelos

Melo

Miot

et al. 2014

An. Bras. Dermatol.

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“…Up to 50% of patients with a positive margin with a cSCC will locally recur with a subsequent increased risk of developing nodal metastases [14]. In a study of patients with lip SCC, those with recurrent lip SCC experienced a significant difference in nodal metastases compared with those not developing local recurrence (15% versus 2%; P < .0001) [15].…”

Section: Incomplete Excision/recurrencementioning

confidence: 99%

High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck

Veness

2007

Journal of Biomedicine and Biotechnology

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Nonmelanoma skin cancers (squamous cell and basal cell carcinomas) occur at an epidemic rate in many countries with the worldwide incidence increasing. The sun-exposed head and neck are the most frequent sites for these cancers to arise and in most patients diagnosed with a cutaneous squamous cell carcinoma, local treatment is usually curative. However, a subset is diagnosed with a high-risk cutaneous squamous cell carcinoma. High-risk factors include size (>2 cm), thickness/depth of invasion (>4 mm), recurrent lesions, the presence of perineural invasion, location near the parotid gland, and immunosuppression. These patients have a higher risk (>10–20%) of developing metastases to regional lymph nodes (often parotid nodes), and in some cases also of experiencing local morbidity (perineural invasion), based on unfavourable primary lesion and patient factors. Despite treatment, many patients developing metastatic cutaneous squamous cell carcinoma experience mortality and morbidity usually as a consequence of uncontrolled metastatic nodal disease. It is therefore important that clinicians treating nonmelanoma skin cancers have an understanding and awareness of these high-risk patients. The aim of this article is to discuss the factors that define a high-risk patient and to present some of the issues pertinent to their management.

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“…With cutaneous SCC less than 2 cm in diameter it has been demonstrated that with a 4-mm clinical excision margin, 95% will have a negative histological excision margin. 24 With lesions more than 2 cm, a 6-mm margin achieved a 95% rate of tumourfree margins. 25 A review of high-risk cutaneous SCC recommended 6-mm margins with high-grade tumours or those located in high-risk areas.…”

Section: Discussionmentioning

confidence: 96%

Cutaneous invasive squamous cell carcinoma: 10‐year experience and recommendations for follow up

Yoong

De’Ambrosis

2009

Aust J Dermatology

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Currently, the National Health and Medical Research Council do not have any recommendations about the frequency of follow up after treatment of primary cutaneous invasive squamous cell cancer (SCC), due to a lack of data. The present study aimed to establish appropriate follow-up times and to determine the long-term risk of subsequent non-melanoma skin cancers and melanoma. Patients who had a primary invasive cutaneous SCC excised during 1996 were retrospectively identified from the databases of a dermatologist in private practice in south-east Queensland. Data on size, site, depth, differentiation, perineural involvement, lymphovascular involvement of the index SCC were obtained. The patients were regularly followed up and lymph-node involvement, patient immunocompetence, and the presence of local recurrences and subsequent SCC, basal cell carcinomas and melanoma were recorded. Forty patients were identified, comprising 25 men and 15 women with a mean age of 65 years. The majority (60%) of primary incident SCC were in the low-risk category. The median follow-up time was 7.5 years. One in two developed a second SCC within 5 years, a significant number had a second SCC detected only in 5-10 year follow up, and 72.5% had a BCC within 5 years, and 82.5% at 10 years. One in eight had a subsequent melanoma detected.

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Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma

Cited by 63 publications

References 37 publications

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis

High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck

Cutaneous invasive squamous cell carcinoma: 10‐year experience and recommendations for follow up

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