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The rate of margins involvement and the associated recurrence risk in basal cell carcinomas (BCCs) varies widely in published works (7%-25% and 26%-67%, respectively). This study investigated the risk factors associated with incomplete excision and their relevance in surgical management when positive margins occur in 3957 BCCs excised in 2358 patients. This study performed a multivariate analysis on the database collected from all patients operated for BCCs in the Plastic Surgery Department between 1 January 1992 and 1 September 2007. All data collected (3957 excisions; 2358 individuals) were divided into complete and incomplete excisions groups and analyzed according to 14 variables. The overall rate of incomplete excisions was 14%. Mean age (68), size of the lesion (< 0.5 cm), BCC subtype (nodular with sclerosant aspects, sclerosant and basosquamous), location (face), infiltration depth (hypodermis and deep tissues), recurrent BCC and re-excised BCC were significantly associated with a higher rate of incomplete excision. The recurrence rate for incompletely excised tumours was 26.8%, while only 5.9% for completely excised tumours. Most of the risk factors associated to incomplete excision can be identified before surgery (by simple anamnesis and clinical examination) and successfully overcome by appropriate surgical margins. The high recurrence rate after incomplete excision and the low patient compliance towards follow-up should lead the surgeon to early re-excise residual cancer.

Basal cell carcinoma (BCC) is the most common skin malignancy. BCC generally has a clinical course characterized by slow growth, minimal local invasiveness, and a high cure rate. Occasionally, however, BCC behaves aggressively with deep tissue invasion, clinical recurrence, and regional/distant metastases. Surgical excision is uniformly indicated as a primary treatment. We carried out a retrospective study by selecting all patients operated for BCC in our Plastic Surgery Department between 1 January 1992 and 1 September 2007. The data collected were about 3,957 excisions performed on 2,358 individuals which is, to our knowledge, the largest population sample ever studied internationally. For this reason, we analyzed the most common BCC features generally reported in published papers so as to identify any difference compared to the data that we gathered in our series. From all of the collected data of the 2,358 patients and 3,957 excisions, 16 variables were drawn, which provided detailed information about patients' status, biopsy when performed, surgery, and follow-up. All results concerning such variables are discussed. The results of our retrospective statistical analysis on a very large, single-center patient population sample are fully in line with what were previously published in the international literature.

W at betreft de onvolledigheid van de definitie van progressieve kos ten zij het volgende opgemerkt:Bij stijgende productie zouden de kosten inderdaad progressief kun nen stijgen door de volgende oorzaken: a. het vaste bestanddeel stijgt in onevenredige mate, omdat men de capaciteit zoodanig uitbreidt, anticipeerend op een verder dóórzet tende stijging van de productie, dat tijdelijk een overcapaciteit ont staat. b. het wisselend bestanddeel stijgt meer dan evenredig door inefficiency. c. er treedt prijsstijging bij één van de, of bij beide elementen op.Onder c. valt het door den Heer van de Graaf genoemde geval van kostenstijging door overwerk. Overigens dient men voor goede analyse van het kostenverloop prijspeil-veranderingen uit te schakelen. Naar mijn meening zal de mogelijkheid a. wel alleen theoretisch zijn, terwijl geval b. stelig practisch is, maar door het zich vertraagd aanpassende vaste kostenbestanddeel de kostensoort zelden progressief zal doen verloopen.

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