Incomplete excision of basal cell carcinoma: a prospective multicentre audit

Kumar, Princy; Watson, S.J.; Brain, Anne; Davenport, Peter; McWilliam, L J; Banerjee, Shoham; Bisset, D.L.

doi:10.1054/bjps.2002.3948

Cited by 74 publications

(77 citation statements)

References 22 publications

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“…O sexo masculino é atribuído como fator de risco para o desenvolvimento de neoplasias cutâneas não melanoma em alguns estudos. 6,10 O sexo feminino correspondeu à parcela mais afetada por lesões em regiões com maior chance de falha terapêutica, metástase e recidivas, 11 como a nasal, periorbitária e malar.…”

Section: Discussionunclassified

“…11,12 De acordo com a região anatômica facial, existe variação quanto ao risco de metástases, comprometimento de bordas, agressividade do tumor e, portanto, maior chance de insucesso do tratamento cirúrgico. 11,13 Isso se deve, entre outras causas, pela tendência de se realizar margens de ressecção mais conservadoras em áreas nobres do corpo, como a face.…”

Section: Anosunclassified

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Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Simoneti

Cunha

Gomes

et al. 2016

Rev. Fac. Ciênc. Méd. Sorocaba

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RESUMOIntrodução: O tumor de pele não melanoma é o de maior prevalência e incidência no Brasil, englobando o carcinoma espinocelular (CEC) e o basocelular (CBC). O principal fator de risco para o desenvolvimento desses tumores é a exposição crônica aos raios solares, justificando a faixa etária e as localizações anatômicas mais acometidas. O tratamento objetiva extirpar a lesão com deformidade mínima. A excisão cirúrgica com margens seguras é a principal opção terapêutica; outras dependem do número de lesões, localização, tipo histológico, estado geral e comorbidades clínicas. Objetivos: Descrever o perfil epidemiológico dos pacientes com tumores cutâneos malignos; identificar a prevalência dos não melanoma; e avaliar a margem cirúrgica. Métodos: Estudo observacional, longitudinal e retrospectivo de pacientes submetidos à ressecção de lesões suspeitas em serviço secundário. Resultados: Foram identificadas 140 lesões em 67 pacientes, sendo 59% do sexo masculino e 71,6% maiores de 60 anos. O segmento mais acometido foi cabeça/pescoço (72,1%); 69,1% eram CBC, 29,2% CEC e 1,6% melanoma; 80,4% informavam margens livres, 7,3% indicavam comprometimento; esses pacientes apresentavam média de 75,2 anos e 8,7 lesões concomitantes. A associação foi significante entre gênero feminino e presença de lesões <5 mm. Conclusões: O predomínio de lesões em indivíduos do sexo masculino acima de 60 anos é compatível com o padrão já descrito na literatura. As margens livres, obtidas em grande parte do presente estudo, indicam eficácia terapêutica da excisão cirúrgica simples. As margens macroscópicas adotadas na marcação pré-operatória favorecem a eficácia, reservando a cirurgia de Möhs para recidivas ou comprometimento de margem. Palavras-chave: neoplasias cutâneas; procedimentos cirúrgicos operatórios; carcinoma de células escamosas; carcinoma basocelular. ABSTRACT Introduction: Non-melanoma skin tumor is the one with highest prevalence and incidence in Brazil, comprising squamous cell carcinoma (SCC) and basal cell carcinoma (CBC). The main risk factor for the development of these tumors is chronic exposure to sunlight, justifying the most affected age group and anatomical locations. Treatment aims to excise the lesion with minimal deformity. Surgical excision with safe margins is the main therapeutic option; others depend on the number of lesions, location, histological type, general health and medical comorbidity. Objectives: To describe the epidemiological profile of patients with skin tumors; to identify the prevalence of non-melanoma; and to evaluate surgical margin. Methods: Observational, longitudinal and retrospective study of patients undergoing resection of suspicious lesions in secondary service. Results: We identified 140 lesions in 67 patients, 59% were male and 71.6% over 60 years of age. The most affected regions were head and neck (72.1%); 69.1% were CBC, 29.2% CBC, and 1.6% melanoma; 80.4% informed free margins, 7.3% indicated affected margins; the mean age of these patients was 75.2 years and the mean number of co...

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Section: Discussionunclassified

Section: Anosunclassified

Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Simoneti

Cunha

Gomes

et al. 2016

Rev. Fac. Ciênc. Méd. Sorocaba

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“…On the basis of the best available literature, the most useful stratification of BCC is provided by the National Comprehensive Cancer Network (NCCN) Guidelines (for recommendation, see Table II; for level of evidence/strength of recommendation, see Table III). 2,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The NCCN stratification, listed in Table IV, takes both clinical and pathologic parameters into account and is based on a combination of available evidence and expert multidisciplinary opinion, including representatives from dermatology, dermatopathology, head and neck surgery, plastic surgery, and surgical, radiation, and medical oncology. Treatment recommendations throughout the current guidelines are based on this stratification.…”

Section: Grading and Stagingmentioning

confidence: 99%

“…When the clinician is submitting biopsy tissue for histopathologic diagnosis, the work group recommends that whenever possible and appropriate, key elements of patient demographics, clinical presentation, and clinical history should be provided to the pathologist (see Table VI; for level of evidence/ strength of recommendations, see Table III). These include patient age and biologic sex, [17][18][19][20][21][22][23][24][25] anatomic location, [17][18][19][20][22][23][24][25][26] and any history of treatment at the same anatomic site. 17,18,22,23 Additional desirable relevant information includes the clinical size of the lesion 17,18,[20][21][22][23][24][25][26] and whether the patient currently, or previously encountered additional risk factors, such as immunosuppression, radiation treatment, or solid organ transplantation.…”

Section: Clinical and Pathologic Informationmentioning

confidence: 99%

“…On the basis of several retrospective and prospective cohort studies, a positive surgical excision margin for BCC is most associated with tumor location in the ''H-zone'' of the face (central face, eyelids, eyebrows, periorbital, nose, lips, chin, mandible, preauricular and postauricular skin/sulci, temple, and ear), aggressive/infiltrative histologic growth pattern, recurrent tumor, and extension beyond the reticular dermis. [17][18][19][20]25 According to current NCCN guidelines, location of BCC in the H-zone constitutes high risk, independent of size. 3 Multiple RCTs comparing standard surgical excision of BCC with topical medical therapy, C&E, photodynamic therapy (PDT), cryotherapy, radiation therapy, and MMS have been published.…”

Section: Standard Excisionmentioning

confidence: 99%

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Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

328

219

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Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed. ( J Am Acad Dermatol

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Factors Contributing to Incomplete Excision of Nonmelanoma Skin Cancer by Australian General Practitioners

Hansen¹,

Wilkinson²,

Hansen³

et al. 2009

Arch Dermatol

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To study rates of incomplete excision of basal (BCC) and squamous (SCC) cell cancer by Australian general practitioners with a special interest. Design: Records review. Setting: A network of 15 primary care skin cancer clinics across Australia. Participants: Fifty-seven physicians performing excisions of 9417 BCCs and SCCs in a single network of 15 primary care skin cancer clinics across Australia between 2005 and 2007. Main Outcome Measures: Rates of incomplete excision according to physician, clinic, anatomic location of the lesion, and whether a previous biopsy had been performed. Results: Four hundred forty-three of 6881 BCCs (6.4%) and 159 of 2536 SCCs (6.3%) were excised incompletely. Incomplete BCC and SCC excisions were more frequent on the head and neck (282 of 2872 excisions [9.8%] and 97 of 861 [11.3%], respectively) than elsewhere. Ears (74 of 388 excisions [19.1%]) and nose (78 of 546 [14.3%]) had the highest rates of incompletely excised BCCs, and ears (26 of 144 excisions [18.1%]) and forehead (20 of 157 [12.7%]) had the highest rates of incompletely excised SCCs. Of all BCC excisions, 67.3% were once-off excisions with no previous biopsy, and these excisions were more likely to be incomplete (odds ratio, 1.73; 95% confidence interval, 1.36-2.20) than those with a previous biopsy. There was, however, substantial variation in frequency of incomplete excision between clinics for BCC (ranging from 3.3% to 24.7%) and SCC (ranging from 0% to 17.2%) and between physicians within clinics (BCC ranging from 0% to 31.1%, and SCC ranging from 0% to 23.5%). Conclusions: Overall frequency of incomplete excision is low and similar to that in other reports. However, high frequency in high-risk sites, low rates of previous biopsy, and substantial variation in performance between physicians and clinics suggests there is significant opportunity to further improve health outcomes.

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Incomplete excision of basal cell carcinoma: a prospective multicentre audit

Cited by 74 publications

References 22 publications

Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Guidelines of care for the management of basal cell carcinoma

Factors Contributing to Incomplete Excision of Nonmelanoma Skin Cancer by Australian General Practitioners

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