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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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Loizate Sarrionandia I, de-la-Rosa Fernández E, González Rodríguez J, Hernández Hernández MN, Pelegrina ME, Castro Tarruella MV, Suárez Hernández J, Fernández-de-Misa Cabrera R. [Translated article] Basal Cell Carcinoma in the Southern Health Area of Tenerife: Key Clinical and Pathological Factors and Margin Status After Excision. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T674-T679. [PMID: 37453537 DOI: 10.1016/j.ad.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision. MATERIAL AND METHODS Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible. RESULTS In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes). CONCLUSIONS The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics.
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Affiliation(s)
- I Loizate Sarrionandia
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - E de-la-Rosa Fernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - J González Rodríguez
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - M N Hernández Hernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - M E Pelegrina
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - M V Castro Tarruella
- Servicio de Anatomía Patológica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - J Suárez Hernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin
| | - R Fernández-de-Misa Cabrera
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spin.
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3
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Loizate Sarrionandia I, de-la-Rosa Fernández E, González Rodríguez J, Hernández Hernández MN, Pelegrina ME, Castro Tarruella MV, Suárez Hernández J, Fernández-de-Misa Cabrera R. Basal Cell Carcinoma in the Southern Health Area of Tenerife. Key Clinical and Pathological Factors and Margin Status After Excision. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:674-679. [PMID: 37100344 DOI: 10.1016/j.ad.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Surgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision. MATERIAL AND METHODS Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible. RESULTS In total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes). CONCLUSIONS The characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics.
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Affiliation(s)
- I Loizate Sarrionandia
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - E de-la-Rosa Fernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - J González Rodríguez
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - M N Hernández Hernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - M E Pelegrina
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - M V Castro Tarruella
- Servicio de Anatomía Patológica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - J Suárez Hernández
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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Stankovic P, Bock R, Rudhart SA, Hoch S, Wilhelm T. Basal Cell Carcinoma of the Head and Neck-A Retrospective Single-Centre Comparison of the Recurrence Rate after R0 or R1 Resection. Facial Plast Surg 2023; 39:155-159. [PMID: 36343630 DOI: 10.1055/s-0042-1756466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The treatment guidelines for basal cell carcinoma (BCC) postulate complete surgical excision using microscopically controlled resection (MOHS) as the gold standard. The need to obtain a small safety margin in the complex anatomical area of the head and neck is very challenging due to the individual characteristics (localization, histology, and size) of tumors and the fact that the postoperative loss of quality of life depends on the surgical defect size. The R1 status is histopathologically defined when the safety margin is less than 1 mm even if there are no tumor cells actually infiltrating the resection margin. Therefore, some studies have already favored a watch-and-wait-strategy in R1 situations. We aimed to evaluate the outcome and recurrence rate of resected BCCs of the head and neck, especially in a histologically proven R1 situation. The outcomes of all resected BCCs observed during a 5-year period (January 2009-December 2013) in a tertiary care center were analyzed. Our standard operating procedure was microscopically controlled surgical excision with reresections until an R0 situation was achieved. In selected patients, an R1 status has been accepted after at least two resections. From the included 191 BCCs, the R1 status was accepted as the final result in 46 (24.1%) cases which had surgically clear margins and were closely followed-up. From 54 patients in the R0 and 40 patients in the R1 group who completed the follow-up (2.4 ± 0.4 years), we observed 0 and 2 local recurrences, respectively (p = 0.19). In cases where frequent follow-up can be secured and the surgical area is delicate, a surgical closure at R1 status can be justified as the recurrence rate is not significantly higher compared with R0.
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Affiliation(s)
- Petar Stankovic
- Department Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - Robert Bock
- Department Otolaryngology, Head and Neck Surgery, Elblandklinikum Riesa, Riesa, Germany
| | - Stefan A Rudhart
- Department Otolaryngology, University Hospital of the Philipps-University Marburg, Marburg, Germany
| | - Stephan Hoch
- Department Otolaryngology, University Hospital of the Philipps-University Marburg, Marburg, Germany
| | - Thomas Wilhelm
- Department Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
- Medical Faculty, Philipps-University Marburg, Marburg, Germany
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Herzum A, Burlando M, Tavilla PP, Micalizzi C, Molle MF, Cozzani E, Parodi A. Dermatoscopically narrowed surgical margins for head and neck basal cell carcinoma: A retrospective case-control study. J Dtsch Dermatol Ges 2022; 20:807-816. [PMID: 35581699 PMCID: PMC9321004 DOI: 10.1111/ddg.14757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head-and neck area, defining both radical and healthy skin sparing surgical margins is complex. MATERIALS AND METHODS Excised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical-dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences. RESULTS Of 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1-2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1-2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively. CONCLUSIONS BCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well-defined and non-aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1-2 mm should be reserved only for BCCs in very difficult-to-treat areas, as the surgical cure rate was only 93 %.
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Affiliation(s)
- Astrid Herzum
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Martina Burlando
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Pietro Paolo Tavilla
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Claudia Micalizzi
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Mattia Fabio Molle
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Emanuele Cozzani
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
| | - Aurora Parodi
- Department of DermatologyDi.S.Sal.University of GenoaSan Martino Polyclinic Hospital IRCCSGenoaItaly
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Herzum A, Burlando M, Tavilla PP, Micalizzi C, Molle MF, Cozzani E, Parodi A. Dermatoskopisch kontrollierte, schmalere Resektionsränder bei Basalzellkarzinomen an Kopf und Hals: Retrospektive Fallkontrollstudie. J Dtsch Dermatol Ges 2022; 20:807-817. [PMID: 35711047 DOI: 10.1111/ddg.14757_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Hintergrund: Unbehandelt kann das Basalzellkarzinom (BCC) erhebliche Gewebezerstörungen verursachen. Die komplette chirurgische Exzision ist die Behandlung der Wahl. Allerdings stellt es besonders im Gesichts- und Halsbereich eine Herausforderung dar, den Tumor vollständig zu entfernen und möglichst viel gesundes Gewebe zu erhalten. Material und Methoden: Bereits exzidierte kleine BCC (≤ 1 cm) von Kopf oder Hals wurden retrospektiv analysiert. Verglichen wurde die histologisch kontrolliert angemessene Breite des Resektionsrandes nach präoperativer dermatoskopischer Untersuchung (Fälle) im Vergleich zur rein klinischen Untersuchung (Kontrollen), sowie die Rezidivrate. Ergebnisse: Bei 281 BCC: 6 % (8/139) der Fälle und 8 % (12/142) der Kontrollen zeigten inadäquate basale Resektionsränder; 4 % (5/139) der Fälle und 20 % (29/142) der Kontrollen zeigten inadäquate laterale Resektionsränder (P < 0.001). Laterale Resektionsränder von 3 mm waren in 0 % (15/66) der Fälle, jedoch in 15 % (10/66) der Kontrollen inadäquat (P >0.005); laterale Resektionsränder von 1-2 mm waren in 7 % (5/73) der Fälle und in 25 % (19/76) der Kontrollen inadäquat (P < 0.01). Rezidive traten in den Fällen mit 3 mm Resektionsrand in 1,5 % auf, in den Fällen mit 1-2 mm Resektionsrand bei 0 %, und bei den Kontrollen bei 7,7 %. Schlussfolgerung: Für BCC im Kopf- und Halsbereich erscheint ein Resektionsrand von 3 mm angemessen, sofern das BCC klein, dermatoskopisch gut definiert und wenig aggressiv ist. Hier zeigten sich operative Heilungsraten von 100 % mit 1,5 % Rezidiven. Resektionsränder von 1-2 mm sollten nur für BCC in sehr schwierig zu behandelnden Bereichen in Betracht gezogen werden, da die Heilungsrate hier nur bei 93 % lag.
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Affiliation(s)
- Astrid Herzum
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Martina Burlando
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Pietro Paolo Tavilla
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Claudia Micalizzi
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Mattia Fabio Molle
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Emanuele Cozzani
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
| | - Aurora Parodi
- Abteilung Dermatologie, Di.S.Sal., Universität Genua, San Martino Polyclinic Hospital IRCCS, Genua, Italien
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Bowe CM, Godhania B, Whittaker M, Walsh S. Pleomorphic dermal sarcoma: a clinical and histological review of 49 cases. Br J Oral Maxillofac Surg 2020; 59:460-465. [PMID: 33441282 DOI: 10.1016/j.bjoms.2020.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm that shares histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumour necrosis, and vascular and perineural invasion, which confers a risk of local recurrence and metastases. To study the clinical and pathological spectrum more comprehensively, we retrieved 49 cases of pleomorphic dermal sarcoma from our departmental files. There was a strong male predominance (n=45). The mean (range) age at presentation was 80 (47-97) years. The tumours had a median (range) maximum dimension of 23.5 (5-75) mm. There was a strong predilection for the head and face (n=47), with the scalp (n=32) being the most common site. Ulceration was observed in 21 patients, tumour necrosis in seven, perineural infiltration in six, and lymphovascular invasion in two. CD10 was expressed in all cases. Smooth muscle actin was expressed in 15 and CD68 in 14. Follow up was available in 41 cases (mean (range) 22.4 (2-90) months). Six patients had local recurrences, despite all having originally undergone primary surgical resections and having reports of clear margins. Progressive metastatic disease was observed in one patient who died from their disease. Based on the Kaplan Meier method, median overall survival was 70.8 (8.4-133.1) months. Although AFX and PDS may be part of a spectrum, distinction is important to emphasise the potential for malignant behaviour in PDS.
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Affiliation(s)
- C M Bowe
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester.
| | - B Godhania
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
| | - M Whittaker
- Department of Pathology, St. Richards Hospital, Chichester
| | - S Walsh
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
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Janssen NNY, Kaufmann M, Santilli A, Jamzad A, Vanderbeck K, Ren KYM, Ungi T, Mousavi P, Rudan JF, McKay D, Wang A, Fichtinger G. Navigated tissue characterization during skin cancer surgery. Int J Comput Assist Radiol Surg 2020; 15:1665-1672. [PMID: 32476078 DOI: 10.1007/s11548-020-02200-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Basal cell carcinoma (BCC) is the most commonly diagnosed skin cancer and is treated by surgical resection. Incomplete tumor removal requires surgical revision, leading to significant healthcare costs and impaired cosmesis. We investigated the clinical feasibility of a surgical navigation system for BCC surgery, based on molecular tissue characterization using rapid evaporative ionization mass spectrometry (REIMS). METHODS REIMS enables direct tissue characterization by analysis of cell-specific molecules present within surgical smoke, produced during electrocautery tissue resection. A tissue characterization model was built by acquiring REIMS spectra of BCC, healthy skin and fat from ex vivo skin cancer specimens. This model was used for tissue characterization during navigated skin cancer surgery. Navigation was enabled by optical tracking and real-time visualization of the cautery relative to a contoured resection volume. The surgical smoke was aspirated into a mass spectrometer and directly analyzed with REIMS. Classified BCC was annotated at the real-time position of the cautery. Feasibility of the navigation system, and tissue classification accuracy for ex vivo and intraoperative surgery were evaluated. RESULTS Fifty-four fresh excision specimens were used to build the ex vivo model of BCC, normal skin and fat, with 92% accuracy. While 3 surgeries were successfully navigated without breach of sterility, the intraoperative performance of the ex vivo model was low (< 50%). Hypotheses are: (1) the model was trained on heterogeneous mass spectra that did not originate from a single tissue type, (2) during surgery mixed tissue types were resected and thus presented to the model, and (3) the mass spectra were not validated by pathology. CONCLUSION REIMS-navigated skin cancer surgery has the potential to detect and localize remaining tumor intraoperatively. Future work will be focused on improving our model by using a precise pencil cautery tip for burning localized tissue types, and having pathology-validated mass spectra.
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Affiliation(s)
| | - Martin Kaufmann
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Alice Santilli
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Amoon Jamzad
- School of Computing, Queen's University, Kingston, ON, Canada
| | | | - Kevin Yi Mi Ren
- Department of Pathology, Queen's University, Kingston, ON, Canada
| | - Tamas Ungi
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Parvin Mousavi
- School of Computing, Queen's University, Kingston, ON, Canada
| | - John F Rudan
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Doug McKay
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Ami Wang
- Department of Pathology, Queen's University, Kingston, ON, Canada
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego M, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego MA, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:291-299. [PMID: 32241529 DOI: 10.1016/j.ad.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists. MATERIAL AND METHODS Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREEII (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review. RESULTS The highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered. CONCLUSIONS This new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences.
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Affiliation(s)
- F Vílchez-Márquez
- Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, España.
| | | | - L Barchino-Ortiz
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Ruíz-de-Casas
- Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Palacios-Álvarez
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
| | - A Soria-Rivas
- Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - L Ríos-Buceta
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
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11
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Nolan GS, Wormald JCR, Kiely AL, Totty JP, Jain A. Global incidence of incomplete surgical excision in adult patients with non-melanoma skin cancer: study protocol for a systematic review and meta-analysis of observational studies. Syst Rev 2020; 9:83. [PMID: 32303259 PMCID: PMC7164252 DOI: 10.1186/s13643-020-01350-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/05/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Non-melanoma skin cancer, which includes basal cell carcinoma and cutaneous squamous cell carcinoma, is the commonest malignancy worldwide. The mainstay of treatment is surgical excision. Despite this being an exceptionally common procedure, it is not known what the accepted standard is for incomplete excision. Multiple single-centre, regional and national studies have previously reported their incidence of incomplete excision in isolation. Furthermore, is it not known what effect potential risk factors such as the operating group, location of lesions, type of reconstruction, histological components or use of loupe magnification have on the incidence of incomplete excisions. The objective of this study will be to systematically evaluate observational data that present incidence of incomplete surgical excision amongst adult patients with non-melanoma skin cancer worldwide. METHODS We designed and registered a study protocol for a systematic review and meta-analysis of descriptive epidemiology data. A comprehensive literature search will be conducted (from January 2000 onwards) in MEDLINE, EMBASE, Scopus, CINAHL, EMCare and Cochrane Library. Grey literature will be identified through searching Open Grey, dissertation databases (e.g. Open Access Theses and Dissertations) and clinical trial registers (e.g. WHO ICTRP). Observational studies (cohort, cross-sectional, case series and clinical audits) reporting the incidence of incomplete surgical excision and conducted in adult patients with non-melanoma skin cancer will be included. The primary outcome will be the incidence of incomplete surgical excision (defined as residual tumour at either the peripheral or deep margin). Secondary outcomes will be risk factors that may affect incomplete excision (e.g. operating group, location of lesions, types of reconstruction, histological components). Data will not be extracted if the study uses other surgical techniques such as Mohs micrographic surgery, intra-operative frozen section, incision, shave or punch biopsies. Two investigators will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. No limitations will be imposed on publication status or language of publication. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effect meta-analysis of observational data. Incidence estimates will be stratified according to cancer type (e.g. basal cell carcinoma vs squamous cell carcinoma) and operating group (e.g. dermatology, plastic surgery and general practice). Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. methodological quality, sample size). DISCUSSION This systematic review will summarise the best available evidence and definitively establish the incidence of incomplete surgical excision in non-melanoma skin cancer. It will determine if there is variation observed amongst different operating groups and provide some evidence for potential other factors causing this difference. This knowledge will provide a standard for future audits and will contribute to improving the treatment of non-melanoma skin cancer treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019157936.
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Affiliation(s)
- Grant S Nolan
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. .,Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR, UK.
| | - Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7LD, UK.,Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Mandeville Rd, Aylesbury, HP21 8AL, UK
| | - Ailbhe L Kiely
- Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK
| | - Joshua P Totty
- Castle Hill Hospital, Hull University Teaching Hospitals, Castle Road, Cottingham, East Riding of Yorkshire, HU16 5JQ, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7LD, UK
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Wysong A, Higgins S, Blalock TW, Ricci D, Nichols R, Smith FL, Kossintseva I. Defining skin cancer local recurrence. J Am Acad Dermatol 2019; 81:581-599. [DOI: 10.1016/j.jaad.2019.03.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/23/2019] [Accepted: 03/29/2019] [Indexed: 12/22/2022]
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13
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Kedilioglu MA, Bos PG, De Jong K, Noordzij NA, Kibbelaar RE, Lapid O, Mouës CM. Whole specimen intraoperative frozen section analysis. Experience with 1082 basal cell carcinomas. Eur J Surg Oncol 2018; 44:157-162. [DOI: 10.1016/j.ejso.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
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Miszczyk J, Charytonowicz M, Dębski T, Noszczyk B. Incomplete excision of basal cell carcinoma (BCC) in the head and neck region: to wait, or not to wait? Postepy Dermatol Alergol 2017; 34:607-611. [PMID: 29422827 PMCID: PMC5799764 DOI: 10.5114/ada.2017.72467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recurrence rates for incompletely excised basal cell carcinoma (BCC) vary widely in the literature. Clinical observation is a commonly accepted method of follow up, however such management of these lesions still remains controversial. AIM To evaluate the rate and factors associated with the recurrence of BCC of the head and neck region after incomplete excision. MATERIAL AND METHODS Medical records of 135 patients with 156 incompletely excised BCCs of the head and neck region were analyzed retrospectively. The primary outcome was the rate of recurrence. Additionally, a correlation of recurrence to clinical and morphological factors was analyzed. RESULTS Recurrence occurred in 72 (46%) lesions. The mean interval to recurrence was 20 months. In each category of factors, the highest relative risk of recurrence was correlated to: location on the scalp - 2.27, diameter over 2 cm - 1.21, nodular clinical form - 1.29, morpheaform histopathological type - 1.67, recurrent lesion - 1.88, irradicality of excision in the lateral margin - 1.24 and closure of the skin defect with the split-thickness skin graft - 1.42 relative risk. CONCLUSIONS Observation is an acceptable management option as less than a half of incompletely excised BCCs recurred and needed further treatment. As 85% of recurrences occur within 3 years after operation, clinical observation should be particularly careful during this period, however long-term recurrence should not be underestimated.
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Affiliation(s)
- Jakub Miszczyk
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, Professor W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Michał Charytonowicz
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, Professor W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Tomasz Dębski
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, Professor W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Bartłomiej Noszczyk
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, Professor W. Orlowski Memorial Hospital, Warsaw, Poland
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Pathological Sampling of Basal Cell Carcinoma Re-excision Specimens: How Much is Enough? Am J Dermatopathol 2017; 39:824-828. [PMID: 29058693 DOI: 10.1097/dad.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cutaneous malignancy, comprising approximately 75%-80% of all skin cancers. Surgical excision is the most common first line treatment modality, with the intent of obtaining clear margins. If the initial excision is incomplete or inadequate, a re-excision will often be performed in an attempt to achieve histological clearance. The pathological examination of these specimens requires a balance between the need for adequate assessment and efficient use of laboratory resources. In this study, we sought to systematically compare different approaches to the pathological sampling of these specimens in the hope of providing an evidential basis for a rational approach. Seventy-four BCC re-excision specimens were entirely sampled and retrospectively examined to determine the rate of detection of residual BCC which would have been achieved using different sampling methodologies. Residual BCC was identified in 37 specimens (50%). Limited transverse sections through the centre of the ellipse resulted in a sensitivity for detection of residual BCC of 78% (or 85% if only "significant" residual tumor is considered). By including the entire scar or the remainder of the specimen except the polar pieces, the sensitivity improved to 95% and 97%, respectively. Only one case showed residual tumor in the apical sections alone, with tumor extending to the new surgical margin in that case. We hope that this data may help laboratories develop sampling protocols appropriate to their own cost-benefit analyses and patient populations.
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Lara F, Santamaría JR, Garbers LEFDM. Recurrence rate of basal cell carcinoma with positive histopathological margins and related risk factors. An Bras Dermatol 2017; 92:58-62. [PMID: 28225958 PMCID: PMC5312180 DOI: 10.1590/abd1806-4841.20174867] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 03/05/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The best way to approach surgically removed basal cell carcinoma with positive histopathological margins is a controversial issue. Some authors believe that the more appropriate treatment is an immediate reoperation while others prefer a periodic follow up. The rates of recurrence are variable in literature, between 10% and 67%. OBJECTIVE: To define the recurrence rate of basal cell carcinoma with positive margins after surgery. Secondarily, identify morphological aspects that can suggest a more frequent tumoral recurrence. METHODS: This was a retrospective and observational study made by analysis of medical records of 487 patients between January 2003 and December 2009 in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). From 402 basal cell carcinomas surgically treated, 41 fulfilled inclusion criteria and were evaluated for five years or more. Recurrence rate of these tumors was analyzed in all patients and clinical characteristics such as sex, age, tumor size, tumor site, ulceration, and histological type were evaluated in order to find if they were related to more common tumoral recurrence. RESULTS: The rate of positive margins after surgery was 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group. Tumor size, site, histological type, ulceration and type of positive margin did not differ statistically between groups. It was not possible to consider if these factors were important in recurrence rates. STUDY LIMITATIONS: Ideally, a prospective study with a larger sample would be more accurate. CONCLUSION: The treatment of choice in basal cell carcinoma with positive margins must be individualized to reduce recurrence rates.
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Affiliation(s)
- Fernanda Lara
- Dermatology Departament - Universidade Federal do Paraná (UFPR) - Curitiba (PR), Brazil
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Troeltzsch M, Probst FA, Knösel T, Mast G, Ehrenfeld M, Otto S. Clinical and pathologic parameters predicting recurrence of facial basal cell carcinoma: a retrospective audit in an advanced care center. Int J Dermatol 2017; 55:1281-1288. [PMID: 27420481 DOI: 10.1111/ijd.13341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/12/2016] [Accepted: 02/28/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center. METHODS A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05. RESULTS A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates. CONCLUSIONS Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.
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Affiliation(s)
- Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Thomas Knösel
- Department of Pathology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Gerson Mast
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians University of Munich, Munich, Germany
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18
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Duinkerken CW, Lohuis PJ, Crijns MB, Navran A, Haas RL, Hamming-Vrieze O, Klop WMC, van den Brekel MW, Al-Mamgani A. Orthovoltage X-rays for Postoperative Treatment of Resected Basal Cell Carcinoma in the Head and Neck Area. J Cutan Med Surg 2016; 21:243-249. [DOI: 10.1177/1203475416687268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Surgery is the golden standard for treating basal cell carcinomas. In case of positive tumor margins or recurrent disease, postoperative adjuvant or salvaging therapy is suggested to achieve good local control. Objective: To retrospectively report on local control and toxicity of postoperative radiotherapy by means of orthovoltage X-rays for residual or recurrent basal cell carcinoma after surgery in the head and neck area. Methods: Sixty-six surgically resected residual or recurrent basal cell carcinomas of the head and neck region were irradiated postoperatively by means of orthovoltage X-rays at the Netherlands Cancer Institute between January 2000 and February 2015. Results: After a median follow-up duration of 30.5 months, only 5 recurrences were reported. The 5-year local control rates at 1, 3, and 5 years were 100%, 87%, and 87%, respectively. The 5-year local control rate was 92% for immediate postoperative radiotherapy of incompletely resected basal cell carcinomas, 90% for recurrences after 1 previously performed excision, and 71% for multiple recurrences, namely, a history of more than 1 excision ( P = .437). Acute toxicity healed spontaneously within 3 months. Late toxicities were mild. Conclusion: Radiotherapy by means of orthovoltage X-ray is an excellent alternative for re-excision in case of incompletely resected or recurrent basal cell carcinomas that are at risk of serious functional and cosmetic impairments after re-excision, with a 5-year local control rate of 87% and a low toxicity profile.
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Affiliation(s)
| | - Peter J.F.M. Lohuis
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Marianne B. Crijns
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Arash Navran
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Rick L.M. Haas
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Olga Hamming-Vrieze
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - W. Martin C. Klop
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Abrahim Al-Mamgani
- Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Konopnicki S, Hermeziu O, Bosc R, Abd Alsamad I, Meningaud JP. Nasal basal cell carcinomas. Can we reduce surgical margins to 3mm with complete excision? ANN CHIR PLAST ESTH 2016; 61:241-7. [PMID: 26879668 DOI: 10.1016/j.anplas.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the incomplete excision rate of nasal basal cell carcinomas (BCC) resected with different margins to demonstrate that 3-mm surgical margins could be used as safety margins to reduce esthetic consequences with a low risk of incomplete excision. METHODS All patients with BCC of the nose excised from January 1st 2008 to December 31st 2011 were included. Data were analyzed and reviewed retrospectively. Tumors were treated with different surgical margins of excision: 3mm, 4mm, and 5mm. The primary outcome variable was the rate of incomplete excision. Other study variables were the histologic subtype, size, and recurrent lesions. RESULTS Of the 132 patients, 115 were included corresponding on with 127 BCC. Median age was 75.5 (64-83) and sex ratio M:F=1.05. Of the 127 BCC, 80 were aggressive histologic subtype (63%), and 11 were recurrent (8.7%). The overall rate of incomplete excision was 17.3% (n=22). Of these 22, 17 (77.3%) were of an aggressive subtype. The incomplete excision rates within the groups were 12.5% (n=4), 22.2% (n=10), and 16% (n=8), respectively within the group with 3-, 4- and 5-mm surgical margins. No significant difference was observed between the groups (P=.519). The incomplete excision rate was not independently associated with the surgical margins, histologic subtype and recurrent type (P>.05). CONCLUSION Three-millimeters margins could possibly be used to treat nasal BCC in chosen cases. Regarding the high rate of incomplete excision, reconstruction should be performed after receiving the pathologic report.
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Affiliation(s)
- S Konopnicki
- Service de chirurgie plastique reconstructrice et esthétique, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - O Hermeziu
- Service de chirurgie plastique reconstructrice et esthétique, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - R Bosc
- Service de chirurgie plastique reconstructrice et esthétique, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - I Abd Alsamad
- Service d'anatomopathologie, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France
| | - J P Meningaud
- Service de chirurgie plastique reconstructrice et esthétique, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Basal cell carcinomata: Risk factors for incomplete excision and results of re-excision. J Plast Reconstr Aesthet Surg 2016; 69:652-6. [PMID: 26948998 DOI: 10.1016/j.bjps.2015.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Re-excision of incompletely excised basal cell carcinomas (BCCs) can be unsatisfactory in the absence of residual tumours. Recommended guidelines do suggest re-excision as a treatment modality; however, its value has been questioned due to low or variable residual tumour presence. We analysed the incomplete excision and re-excision rates and the presence of residual tumours over an 18-month period in a single unit. METHOD Using pathology results and case notes, 2586 primary excisions of BCCs in 1717 patients were reviewed. RESULTS The incomplete excision rate was reported to be 7.1% (184/2586). Excision of a lesion by multiple excision lesion procedure was associated with a higher rate of incomplete excision when compared to single lesion excision procedure (61.5% vs. 38.5%). Of the incompletely excised BCCs, 33.6% (62/184) were re-excised, of which 62.9% (39/62) had residual tumours. Although the figures are small, most anatomical sites examined had a residual tumour presence >50%. CONCLUSION After evaluating each patient individually, considering the high residual tumour rate, re-excision of an incompletely excised BCC would be a worthwhile procedure.
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Boehringer A, Adam P, Schnabl S, Häfner HM, Breuninger H. Analysis of incomplete excisions of basal-cell carcinomas after breadloaf microscopy compared with 3D-microscopy: a prospective randomized and blinded study. J Cutan Pathol 2015; 42:542-53. [DOI: 10.1111/cup.12535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Patrick Adam
- Department of Pathology; Eberhard-Karls-University; Tuebingen Germany
| | - Saskia Schnabl
- Department of Dermatology; Eberhard-Karls-University; Tuebingen Germany
| | | | - Helmut Breuninger
- Department of Dermatology; Eberhard-Karls-University; Tuebingen Germany
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Luz FB, Ferron C, Cardoso GP. Surgical treatment of basal cell carcinoma: an algorithm based on the literature. An Bras Dermatol 2015; 90:377-83. [PMID: 26131869 PMCID: PMC4516103 DOI: 10.1590/abd1806-4841.20153304] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/13/2014] [Indexed: 01/06/2023] Open
Abstract
Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.
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Affiliation(s)
| | - Camila Ferron
- Fluminense Federal University (UFF) – Niterói (RJ), Brazil
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Ennouhi MA, Moussaoui A. [Basal cell basal cell epithelioma of the face: surgical management, about 45 cases and review of the literature]. Pan Afr Med J 2015; 19:80. [PMID: 25709738 PMCID: PMC4332336 DOI: 10.11604/pamj.2014.19.80.5187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/14/2014] [Indexed: 12/05/2022] Open
Abstract
L’épithélioma basocellulaire est de loin la tumeur épithéliale maligne la plus répandue. L'atteinte faciale représente plus de 65% des cas et constitue un facteur de risque de récidive. L'objectif de notre travail est de rappeler les principes et modalités du traitement chirurgical. Sur une période de douze mois, nous avons pris en charge quarante-cinq patients atteints de carcinomes basocellulaires de la face. Le traitement chirurgical comprend deux volets: -carcinologique: emportant la tumeur et une marge de tissu sain; -et une chirurgie réparatrice faisant appel à la suture cutanée directe; greffes ou lambeaux loco -régionaux. L'examen histologique systématique des pièces opératoires permet la confirmation du diagnostic, le typage histologique et l'appréciation de la qualité de l'exérèse chirurgicale. Les résultats esthétiques sont jugés satisfaisants. Quant aux résultats carcinologiques, nous déplorons quatre récidives. Le traitement chirurgical des épithéliomas basocellulaires est le seul garant de la guérison. Au niveau de la face, il faut trouver le meilleur compromis entre impératifs carcinologiques et esthétiques. L'amélioration des résultats passe par: la prévention, le dépistage précoce des lésions, la collaboration étroite des anatomo-pathologistes et la création de comités de concertation pluri -disciplinaire pour la prise en charge des cas difficiles.
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Affiliation(s)
- Mohamed Amine Ennouhi
- Service de Chirurgie Plastique, Réparatrice et des Brûlés, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Abdenacer Moussaoui
- Service de Chirurgie Plastique, Réparatrice et des Brûlés, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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Borroni RG, Barruscotti S, Carugno A, Barbaccia V, Arbustini E, Brazzelli V. Usefulness ofin vivophotodiagnosis for the identification of tumor margins in recurrent basal cell carcinoma of the face. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:195-201. [DOI: 10.1111/phpp.12166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Riccardo G. Borroni
- Laboratori Sperimentali di Ricerca - Area Trapiantologica; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Andrea Carugno
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Vincenzo Barbaccia
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Eloisa Arbustini
- Laboratori Sperimentali di Ricerca - Area Trapiantologica; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
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Ito T, Inatomi Y, Nagae K, Nakano-Nakamura M, Nakahara T, Furue M, Uchi H. Narrow-margin excision is a safe, reliable treatment for well-defined, primary pigmented basal cell carcinoma: an analysis of 288 lesions in Japan. J Eur Acad Dermatol Venereol 2014; 29:1828-31. [PMID: 25186070 DOI: 10.1111/jdv.12689] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete excision is the most promising treatment for basal cell carcinoma (BCC) and a surgical margin of at least 4 mm is recommended. However, little is known about the appropriate surgical margin of pigmented BCC. OBJECTIVE To investigate the reliability of narrower margin excision of well-defined, pigmented BCC. METHODS We identified a total of 263 patients with 288 well-defined, primary pigmented BCC at the Department of Dermatology, Kyushu University (Fukuoka, Japan), between January 2006 and December 2013. All lesions were surgically excised with 1-6-mm margins and analysed. For 30 recent lesions out of the 288 lesions, border gaps between dermoscopy and histopathology were assessed. RESULTS Of the 288 lesions, 218 (75.7%) were excised with a narrow margin (≤ 3 mm) and 60 lesions (24.3%) with a wide margin (≥ 4 mm). Only two lesions (0.7%), which were excised with 2-mm margins, were associated with tumour-positive margins. Narrow-margin excision showed a complete removal rate of 99% (2-mm margins, 95.3%; 3-mm margins, 100%). Dermoscopically determined borders almost exactly corresponded to the histopathological ones; 71.2% of border gaps between dermoscopy and histopathology were within 1 mm and there were no cases in which tumours spread beyond 1 mm of their dermoscopic borders. CONCLUSION Surgical excision with a 2-3-mm margin is reliable treatment for well-defined, primary pigmented BCC, with a complete removal rate of 99%.
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Affiliation(s)
- T Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Inatomi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Nagae
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Nakano-Nakamura
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma? Ann Plast Surg 2014; 72:579-83. [DOI: 10.1097/sap.0b013e31826524df] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Demirseren DD, Ceran C, Aksam B, Demirseren ME, Metin A. Basal cell carcinoma of the head and neck region: a retrospective analysis of completely excised 331 cases. J Skin Cancer 2014; 2014:858636. [PMID: 24864212 PMCID: PMC4016886 DOI: 10.1155/2014/858636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60-70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (n = 9, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs.
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Affiliation(s)
- Duriye Deniz Demirseren
- Department of Dermatology, Ataturk Training and Research Hospital, Bilkent Way, 06800 Ankara, Turkey
| | - Candemir Ceran
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Berrak Aksam
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Mustafa Erol Demirseren
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Ahmet Metin
- Department of Dermatology, Ataturk Training and Research Hospital, Bilkent Way, 06800 Ankara, Turkey
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Knani L, Romdhane O, Ben Rayana N, Mahjoub H, Ben Hadj Hamida F. Étude clinique et facteurs de risque de récidive des carcinomes basocellulaires des paupières : résultats d’une série tunisienne et revue de la littérature. J Fr Ophtalmol 2014; 37:107-14. [DOI: 10.1016/j.jfo.2013.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/27/2013] [Indexed: 10/25/2022]
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Abstract
This article focuses on the surgical treatment of nonmelanoma skin cancers of the head and neck. The risk factors of nonmelanoma skin cancers for recurrence and metastases that are important for choosing the best treatment option are summarized. Surgical treatment options including surgical excision with standard margins, frozen section, staged surgery, and Mohs micrographic surgery are described. Indications, techniques, outcomes, and advantages and disadvantages of each approach are reviewed. Finally, management of incomplete excisions is discussed.
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Krema H, Herrmann E, Albert-Green A, Payne D, Laperriere N, Chung C. Orthovoltage radiotherapy in the management of medial canthal basal cell carcinoma. Br J Ophthalmol 2013; 97:730-4. [DOI: 10.1136/bjophthalmol-2012-302991] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bassas P, Hilari H, Bodet D, Serra M, Kennedy F, García-Patos V. Evaluation of Surgical Margins in Basal Cell Carcinoma by Surgical Specialty. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pazdrowski J, Dańczak-Pazdrowska A, Golusiński P, Szybiak B, Silny W, Golusiński W. [The recurrence of facial basal cell carcinoma in patients treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010]. Otolaryngol Pol 2012; 66:185-90. [PMID: 22748679 DOI: 10.1016/s0030-6657(12)70767-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/01/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The incidence of basal-cell carcinomas (BCC) in Europe is estimated at 10 cases per 100,000 people and is continuously increasing. Recurrent cases of BCC tend to have a more aggressive progression. The treatment methods include: conventional surgery, Mohs surgery, laser therapy, cryosurgery, curettage and radiotherapy. The recurrence of basalcell carcinoma depends on the method of treatment and ranges between 4% and 18%. In the case of recurrent BCC the treatment method of choice is margin control surgery. AIM OF THE STUDY The purpose of this paper is to conduct a retrospective analysis of patients with facial BCC treated with classic surgery and laser therapy as well as to present a strategy for action in the case of recurrence. MATERIAL AND METHODS The retrospective analysis was conducted on patients with diagnosed facial BCC, treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010. The research included 58 patients aged 56-80; 34 women and 24 men. RESULTS Out of 58 patients 8 had recurrent BCC - 4 cases after laser therapy (Group A), and 4 cases after classic surgery (Group B). In 2 cases from Group A and all cases from Group B further treatment involved removal of the recurrent tumour by margin control surgery and skin flap plastic surgery. In 2 remaining cases from Group A further CO(2) laser therapy was performed under local anaesthesia and analgosedation. This type of treatment was chosen due to general medical and cardiological concerns which disqualified the use of general anaesthesia and conventional surgery. So far no further local recurrent cases of BCC have been diagnosed, and the follow-up periods range from 4 to 26 months. CONCLUSION Recurrent cases of BCC are 10% more frequent in patients treated with cryosurgery or laser therapy without margin control than in patients who had the tumour removed by margin control surgery. Margin control surgery remains the method of choice in cases involving large tumours, recurrence or spread by invasion.
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Affiliation(s)
- Jakub Pazdrowski
- Oddział Chirurgii Głowy i Szyi i Onkologii Laryngologicznej Wielkopolskiego Centrum Onkologii.
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Fernandes S, Macias VC, Cardoso J. Effect of positive surgical margins after initial surgical resection for basal cell carcinoma. Dermatol Surg 2012; 39:139-40. [PMID: 22928594 DOI: 10.1111/j.1524-4725.2012.02565.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Use of an audit to improve surgical treatment of facial basal cell carcinoma. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0751-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Bassas P, Hilari H, Bodet D, Serra M, Kennedy FE, García-Patos V. Evaluation of surgical margins in Basal cell carcinoma by surgical specialty. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:133-40. [PMID: 22835227 DOI: 10.1016/j.ad.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 05/28/2012] [Accepted: 06/02/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Complete surgical excision is the most common treatment for basal cell carcinoma (BCC), and this intervention is often performed by surgeons who are not dermatologists (e.g., plastic surgeons, general surgeons, oral and maxillofacial surgeons, ophthalmologists, and otorhinolaryngologists). OBJECTIVES To determine positive margin rates in BCCs removed by surgeons from different specialties and to identify clinical and pathologic factors that might explain potential differences between specialties. METHODS We retrospectively reviewed the pathology reports of all BCCs diagnosed at Hospital Universitari Vall d'Hebron between January 2009 and March 2001. The statistical methods included a descriptive analysis of clinical and pathologic variables, standard statistical analyses, and multivariate logistic regression. RESULTS We included 921 BCCs from 750 patients; 549 of the tumors had been excised by a dermatologist. The overall positive margin rate was 12.6%, but the rate for tumors removed by dermatologists was significantly lower than that for those removed by other specialists (6.7% vs 21.5%). There was a 3.8-fold increased relative risk of positive margins following excision by a surgeon who was not a dermatologist, independently of patient age, tumor site, maximum diameter of the resected specimen, and histologic subtype. CONCLUSIONS Accurate macroscopic identification of tumor margins, which are often difficult to see, and familiarity with the natural history of BCC are key factors in the successful surgical treatment of BCCs. The higher rate of tumor-free margins achieved by dermatologists in this study is probably mainly due to their greater experience in these 2 areas.
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Affiliation(s)
- P Bassas
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
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Abstract
BACKGROUND With the continuing increase in the incidence of skin cancer, delivery of cost-efficient skin cancer treatment is a top priority. OBJECTIVE To compare costs associated with removal of skin cancers using Mohs micrographic surgery (MMS) with that using standard surgical excision (SSE) with frozen or permanent margin control in the office or an ambulatory surgery center (ASC). METHODS AND MATERIALS Costs for actual MMS and calculated costs for all SSE were recorded. The expense of treatment of incomplete excisions with subsequent reexcision and reconstruction and MMS on recurrent tumors were added to the final estimate. RESULTS Four hundred six tumors were included in the study. An average tumor was cleared in 1.6 stages. MMS was the least expensive surgical procedure evaluated, at $805 per tumor. SSE with permanent margins ($1,026) was more expensive than MMS but less expensive than SSE with frozen margins ($1,200) and ASC-SSE with frozen margins ($2,507). Adjusted for inflation, the cost of MMS, inclusive of initial examination, biopsy, and 5-year follow-up, in 2009 ($1,376) was lower than in 1998 ($1,635). CONCLUSIONS This study confirms MMS as the cornerstone of cost-effective treatment, regardless of place of service or type of margin control pathology.
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Affiliation(s)
- Larisa Ravitskiy
- Department of Dermatology, Ohio Skin Cancer Institute, Ohio State University, Columbus, Ohio 43230, USA
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Jankovic I, Kovacevic P, Visnjic M, Jankovic D, Binic I, Jankovic A. Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence? An Bras Dermatol 2011; 85:872-7. [PMID: 21308312 DOI: 10.1590/s0365-05962010000600014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. OBJECTIVE To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. METHODS This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. RESULTS No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. CONCLUSION A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus.
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Affiliation(s)
- Irena Jankovic
- Plastic and Reconstructive Surgery Clinic, Clinical Center Nis, Serbia.
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Treatment of facial Basal cell carcinoma: a review. J Skin Cancer 2011; 2011:380371. [PMID: 21773034 PMCID: PMC3135095 DOI: 10.1155/2011/380371] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/23/2011] [Accepted: 01/27/2011] [Indexed: 11/17/2022] Open
Abstract
Basal cell carcinomas (BCCs) are locally destructive malignancies of
the skin. They are the most common type of cancer in the western
world. The lifetime incidence may be up to 39%. UV exposure is the
most common risk factor. The majority of these tumours occur on the
head and neck. Despite BCCs being relatively indolent the high
incidence means that their treatment now contributes a significant and
increasing workload for the health service. A good understanding of
the options available is important. Management decisions may be
influenced by various factors including the patient's age and
comorbidities and the lesion subtype and location. Due to the
importance of a good cosmetic and curative outcome for facial BCCs
treatment decisions may differ significantly to those that would be
made for BCCs arising elsewhere. There is little good randomized
controlled data available comparing treatment modalities. Although
traditionally standard excision has been the treatment of choice
various other options are available including: Mohs micrographic
surgery, curettage and cautery, cryosurgery, radiotherapy, topical
imiquimod, photodynamic therapy and topical 5-fluorouracil. We
discuss and review the literature and evidence base for the treatment
options that are currently available for facial BCCs.
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Santiago F, Serra D, Vieira R, Figueiredo A. Incidence and factors associated with recurrence after incomplete excision of basal cell carcinomas: a study of 90 cases. J Eur Acad Dermatol Venereol 2011; 24:1421-4. [PMID: 20384689 DOI: 10.1111/j.1468-3083.2010.03662.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Management of incompletely excised basal cell carcinomas (BCC) remains controversial. OBJECTIVE The aim of this study was to assess the rate and the factors associated with the recurrence of incompletely excised BCC. METHODS In this retrospective monocentric study, data from all surgically excised BCC during 4 years (2000 to 2003) were analysed. RESULTS A total of 947 BCC were excised. Of these, 90 were incompletely excised (9.5%). This group was kept under clinical follow-up for a median period of 62.5 months (range 12-84). Recurrence was confirmed in 29 patients (32.2%). The median interval to recurrence was 12 months (range 1-57). Recurrence of incompletely excised BCC was significantly higher (P < 0.05) in younger patients, in aggressive histological types and in localizations like postauricular and nasogenian folds. CONCLUSION Observation might be an acceptable option in many situations, but for patients with aggressive types of BCC, or with tumours localized in risk areas of the face, immediate re-excision appears to be the treatment of choice. A careful follow-up is indicated for at least 3 years; however, long lasted recurrence should not be underestimated.
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Affiliation(s)
- F Santiago
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal.
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What Is the Best Surgical Margin for a Basal Cell Carcinoma: A Meta-Analysis of the Literature. Plast Reconstr Surg 2010; 126:1222-1231. [DOI: 10.1097/prs.0b013e3181ea450d] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rieger KE, Linos E, Egbert BM, Swetter SM. Recurrence rates associated with incompletely excised low-risk nonmelanoma skin cancer. J Cutan Pathol 2009; 37:59-67. [PMID: 19615009 DOI: 10.1111/j.1600-0560.2009.01340.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reported recurrence rates for transected nonmelanoma skin cancer (NMSC) vary widely, and few studies have addressed recurrence of tumors followed clinically or treated with nonsurgical modalities. METHODS Retrospective review of dermatopathology records from January 1999 to January 2005 was conducted to identify biopsies or excision specimens with histologically transected basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) which were not subsequently excised. Patient and tumor characteristics associated with recurrence were analyzed in a subgroup of patients with predominantly 'low-risk' and/or minimally transected NMSCs. Prospective follow up was performed through March 31, 2008. Data was analyzed with Chi-square and Fishers exact tests and multivariate logistic regression. RESULTS Of 376 transected NMSCs, 27 (7.2%) recurred, including 20 (9%) of 223 BCCs and 7 (4.6%) SCCs in situ of 153 SCCs. The overall recurrence rate of the 124 minimally transected NMSCs was even lower (5.6%). Multivariate logistic regression identified three significant predictors of recurrence: tumor location on the head and neck (p = 0.041), tumor size (p = 0.00741) and superficial subtype of BCC (p = .035). CONCLUSIONS Although surgical excision of NMSC remains the standard of care, observation or nonsurgical treatment may be acceptable in many cases of incompletely excised low-risk or minimally transected NMSCs.
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Affiliation(s)
- Kerri E Rieger
- Department of Dermatology, Stanford University Medical Center, Stanford, CA 94305, USA
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Veness MJ, Chong L, Tiver K, Gebski V. Basal cell carcinoma of the nose: an Australian and New Zealand radiation oncology patterns-of-practice study. J Med Imaging Radiat Oncol 2009; 52:382-93. [PMID: 18811764 DOI: 10.1111/j.1440-1673.2008.01974.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with a basal cell carcinoma (BCC) of the nose may be recommended radiotherapy (RT) with a wide variation in techniques and prescribed dose fractionation schedules between clinicians. The aim of this study was to ascertain variability in the patterns of practice among Australian and New Zealand radiation oncologists (ROs) when treating BCC arising on the nose. A postal survey was sent to 222 practising ANZ ROs detailing 12 different clinical scenarios of a BCC arising on the nose. The treatment selected for each scenario was analysed according to clinician's attitudes, training, experience and the availability of resources. The response rate was 74% (165/222) with 90 respondents treating non-melanoma skin cancer. Training was perceived to have a marked influence on treatment practice by most (79%). In total, 72% of ROs were 'very certain' in their choice of a dose fractionation schedule for obtaining local control and 61% for a satisfactory cosmetic outcome, respectively. Most (76%) favoured low-voltage photons over electrons as the optimal method of treatment, although for certain clinical scenarios most would use electrons. Dose fractionation schedules were highly variable with a lower total dose and hypofractionation favoured for older patients. Low-voltage photons were favoured for the T1 BCC and electrons for the T2 and T4 BCC. Nearly one-third of the ROs chose megavoltage photons for the T4 lesion. There is marked variation in treatment practices in terms of recommending RT over other treatment options, the choice of RT method, the dose fractionation schedule, the extent of field margins and the point of dose prescription.
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Affiliation(s)
- M J Veness
- Department of Radiation Oncology, Westmead and Nepean Hospitals, Westmead, NSW, Australia.
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Tarallo M, Cigna E, Frati R, Delfino S, Innocenzi D, Fama U, Corbianco A, Scuderi N. Metatypical basal cell carcinoma: a clinical review. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2008; 27:65. [PMID: 18992138 PMCID: PMC2585560 DOI: 10.1186/1756-9966-27-65] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/07/2008] [Indexed: 11/15/2022]
Abstract
Background Metatypical cell carcinoma can be considered as a new entity of skin cancer, being an intermediate typology between basal cell carcinomas and squamous cell carcinomas. The behaviour of the metatypical cell carcinoma lies between these two varieties of skin cancer. It is difficult to perform a differential diagnosis based on morphological and clinical features – therefore it is only possible by accurate histology. Methods The authors have retrospectively analysed clinical records of 240 patients who were affected by metatypical skin cancer and who were treated by surgery, radiotherapy and chemotherapy. Results MTC affected more males than females (62.5% vs 37.5%) than males. The most affected site was the cervicofacial area, 71.7%; then the trunk, 10%; the limbs, 9.6%; the scalp 3.7%; and other regions 5%. A recurrence occurred in 24 cases (10%), mainly in head and neck area. Conclusion In this manuscript, the authors have emphasised the importance of conducting a differential diagnosis, and the importance of the specific treatment for metatypical skin cancer, even though more clinical studies and long-term follow-ups are required before establishing specific guidelines.
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Affiliation(s)
- Mauro Tarallo
- Department of Dermatology and Plastic Surgery, University La Sapienza, Rome, Italy.
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Abstract
This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- N R Telfer
- Dermatology Centre, Salford Royal Hospitals NHS Foundation Trust, Manchester M6 8HD, UK.
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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 identified: 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 difficulty 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 difficulty 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 significant 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 significant 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.
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Affiliation(s)
- P Longhi
- Department of Plastic and Reconstructive Surgery "Ospedali Riuniti di Bergamo", Bergamo, Italy
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Veness MJ. The important role of radiotherapy in patients with non-melanoma skin cancer and other cutaneous entities. J Med Imaging Radiat Oncol 2008; 52:278-86. [PMID: 18477123 DOI: 10.1111/j.1440-1673.2008.01956.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-melanoma skin cancer is the commonest malignancy worldwide and a significant public health issue. Although most non-melanoma skin cancers are small and easily excised or ablated, a recommendation of definitive radiotherapy is often made in patients where the outcome (cosmetic and/or functional) will probably be better with radiotherapy compared to surgery. The aim of adjuvant radiotherapy is to reduce the risk of loco-regional recurrence and the role of palliative radiotherapy is important in improving the quality of life in patients with advanced and/or incurable disease. The aim of this review article is to broadly discuss the various clinical settings in which a recommendation of radiotherapy may be made and also includes a discussion on less frequently encountered cutaneous entities (e.g. in situ squamous cell carcinoma, keratocanthoma, lentigo maligna, cutaneous lymphomas and malignant fibrous tumours).
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Affiliation(s)
- M J Veness
- Department of Radiation Oncology, Westmead Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.
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Bailey JS, Goldwasser MS. Surgical management of facial skin cancer. Oral Maxillofac Surg Clin North Am 2007; 17:205-33, vi. [PMID: 18088778 DOI: 10.1016/j.coms.2005.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical excision is the gold standard for management of cutaneous basal cell carcinoma or squamous cell carcinoma. Surgical management of nonmelanotic facial skin cancer requires preoperative planning and an in-depth understanding of reconstructive techniques, including primary closure, skin grafting, and local tissue flaps. The decision regarding the method of treatment of nonmelanotic skin cancer is highly individualized and depends on patient age, cancer size, histologic subtype, and site. No single therapy or technique can be used in every situation. The goals of treatment include complete removal of the lesion with preservation of normal tissue, function, and cosmesis. In this article we discuss the principles and techniques of surgical excision and reconstruction of site-specific facial skin cancers.
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Affiliation(s)
- Jonathan S Bailey
- Department of Surgery, University of Illinois College of Medicine at Urbana-Champaign, IL, USA.
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Ríos-Buceta L. Actitud ante los epiteliomas basocelulares con bordes afectos. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70160-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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