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

Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?

OBJECTIVE

To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs.

METHODS

Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes.

RESULTS

Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001).

CONCLUSIONS

Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.

Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

Introduction

Cutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies.

Objective

The purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma.

Methods

We developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed “inadequate” or “incomplete”. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression.

Results

In total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins.

Conclusion

Gross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins.

Role of Intraoperative Clean Surgical Margin Determined With Lesion Size and Duration to Obtain Apropriate Histological Clean Surgical Margin in High-Risk Basal Cell Carcinoma Patients, According to National Comprehensive Cancer Network Criteria

We aimed to elucidate the role of intraoperative clean surgical margin (iCSM) determined according to lesion size and duration to obtain appropriate histological clean surgical margin (hCSM) in high-risk basal cell carcinoma (BCC) patients evaluated according to National Comprehensive Cancer Network (NCCN) criteria considering the tumor size and/or location. The contribution of lesion area to determine iCSM was also evaluated. Patients with high-risk BCC requiring surgical management were included. iCSM, hCSM, and clinical variables including sec, age, longest edge, location and area, and follow-up duration were recorded. In total, 96 lesions were evaluated. Lesions were mostly located in the mask area and other face region (93.8%). Lesions located on the nose comprised 50%, 34.1%, and 26.3% in the BCC-5, BCC-7, and BCC-10 lesions, respectively. The hCSMs were positive in 11.5%, 9.1%, and 3.8% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The deep surgical margin was positive in 15.4%, 4.5%, and 7.7% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The calculated risk for the positive surgical margin if the BCC-10 lesions were done like the BCC-7 was 15.4%. No recurrence was during follow-up duration. As supported by the findings of the present study, to obtain an adequate hCSM in the high-risk BCC lesions, the iCSM determined according to NCCN recommendations may not be optimal. Nevertheless, after their categorization according to lesion size and disease duration for excision with 5-, 7-, and 10-mm iCSMs, it is possible to obtain a small but important improvement in the outcome of patients.