Treatment of Pigmented Basal Cell Carcinoma with 3 mm Surgical Margin in Asians

Abstract

Background. In Asians, most basal cell carcinomas (BCCs) are pigmented with clear borders. The consensus of 4 mm surgical margin for BCC largely depends on studies in nonpigmented BCCs in Caucasians. However, little is known about recurrences of pigmented BCCs with a narrower surgical margin. We aimed to investigate 5-year recurrence of BCCs, either pigmented or nonpigmented, in Taiwanese with 3 mm surgical margin. Materials and Methods. 143 patients with BCC (M/F = 66/77, average 64 years) were confirmed pathologically from 2002 to 2013. Based on the pathological margin (>1 mm, ≤1 mm, and involved), patients were categorized into the complete excision group (n = 77), histology with close proximity group (n = 43), and unclear surgical margin group (n = 23). Results. Among 143 cases, 105 were pigmented. With standard 3 mm excision, there were 7 recurrences, with 6 of them from nonpigmented BCC group. Logistic regression showed that pigmentation was associated with lower recurrence. Interestingly, 5-year recurrence of completely excised and histology with close proximity BCC (0/77 versus 1/43) was not different statistically. Conclusions. A 3 mm surgical margin is adequate for pigmented BCC. A “wait and see” approach rather than further wide excision is appropriate for BCC with <1 mm free margin.

Surgical Margin of Excision in Basal Cell Carcinoma: A Systematic Review of Literature

“…They used a 5-year follow-up design to determine whether a 3 mm surgical margin was appropriate for excision of pigmented and non-pigmented BCC, and they used recurrence as the outcome measurement. They concluded that a 3 mm margin is adequate for excision of pigmented BCC, but non-pigmented BCC had a higher risk of recurrence and thus needs careful follow up [ 12 ].…”

2‐mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas

“…7 However, only one patient (0.95%) showed local recurrence during a 5-year follow-up. 7 Nakamura et al investigated the appropriate surgical margins in 120 Japanese BCC patients. 16 They reported that complete excision was achieved in 51 low-risk BCC cases regardless of margin width.…”

“…In a cohort of Japanese patients with BCC, Takenouchi et al 6 reported that the 5-and 10-year recurrence rates after complete excision without use of MMS were 0.4% and 0.8%, respectively. Further, in a group of Taiwanese patients with BCC, Lin et al 7 reported a 5-year local recurrence rate of 2.3% even in a group with close margins (within 1 mm). Therefore, the use of MMS is very limited in Japan and few institutions have the equipment and trained technicians for performing MMS.…”

“…reported that the 5‐ and 10‐year recurrence rates after complete excision without use of MMS were 0.4% and 0.8%, respectively. Further, in a group of Taiwanese patients with BCC, Lin et al . reported a 5‐year local recurrence rate of 2.3% even in a group with close margins (within 1 mm).…”

“…In recent years, several studies from Asia have reported that side margin positivity rates and local recurrence rates in primary pigmented BCCs with well-defined clinical tumour borders are lower in patients treated with surgical margins that are narrower than those recommended by the guidelines; this is particularly true for nodular and superficial BCCs. 4,7 However, these reports mainly focused on pigmented BCCs. Other BCC subtypes such as those with poorly defined clinical tumour borders, aggressive histologic subtypes, non-pigmented lesions and high-risk lesions have not been well investigated.…”