Recurrence rate of basal cell carcinoma among different micrographic surgery techniques: systematic review with meta‐analysis

Abstract

In high-risk basal cell carcinomas (BCCs), micrographic surgery (MS) has high tissue preservation and low recurrence rates. The Mohs technique is the most commonly used technique, with limited use of other MS techniques. No studies have been designed to compare the MS methods. This review aimed to assess BCC recurrence rates of different MS techniques. A systematic review and meta-analysis were conducted to search for related studies in PubMed, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL and COCHRANE until March 2021. Randomized clinical trials (RCTs) and observational studies involving patients with BCC and indications for different MS techniques were included. Study selection and data extraction were performed independently by three peer reviewers, as was the risk of bias assessment using the Joanna Briggs Institute tool. Pooled estimates were assessed using the random-effects model (Logit), and heterogeneity was assessed by the chi-squared test (v 2 ). Stata Software version 17.0 was used for analysis. Eighteen studies were included, two RCTs and sixteen observational studies. The overall recurrence rate was 2% (95% CI, 1.0-3.0%; v 2 = 46.2; P = 0.00; 18 studies, 10 424 BCCs). In studies using the Mohs technique, the recurrence rate was 3.0% (95% CI, 1.0-5.0%; v 2 = 11.0; P = 0.00; 6 studies; 1,582 BCCs), with the Munich technique 3.0% (95% CI, 2.0-5.0%; v 2 = 0.0; no heterogeneity; 3 studies; 404 BCCs), with Tubingen technique 1% (95% CI, 1.0-2.0%; v 2 = 12.1; P = 0.00; 8 studies; 8374 BCCs) and with the Muffin technique 0.0% (95% CI, 0.0-6.0%; 1 study; 64 BCCs). Relapse rates between MS techniques were low and appeared to be similar. However, the design of this review and the absence of primary studies that directly compare the techniques do not allow us to assert the superiority between them.

Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: A systematic review and meta‐analysis

“…6 Moreover, various MS techniques appear to yield comparable cure rates. 47 Nevertheless, aspects involving tumour recurrence in MS despite the evaluation of 100% of the lateral and deep margins have not been systematically investigated. Possible factors that justify recurrence in MS would be (i) discontinuity of tumour blocks (e.g.…”

“…A meta‐analysis encompassing RCTs examining all treatments for primary BCC reported a recurrence rate of 3.2% for MS and 5.2% for CS over a 5‐year follow‐up period (RR 0.61; 95% CI 0.18–2.04) 6 . Moreover, various MS techniques appear to yield comparable cure rates 47 . Nevertheless, aspects involving tumour recurrence in MS despite the evaluation of 100% of the lateral and deep margins have not been systematically investigated.…”

Oncological aspects related to the non-surgical treatment of basal cell carcinoma – Response

“… 2 It is also known that only micrographic surgery using the Munich technique could assertively confirm the absence of disease throughout the scar, even five years after the treatment. 3 …”