Reducing the learning curve for the treatment of morphoeic (sclerosing) basal cell carcinoma of the face

Abstract

The treatment of morphoeic (or sclerosing) basal cell carcinoma (mBCC) of the face is associated with high rates of incomplete excision and recurrence. A principal risk factor for incomplete resection is the grade of surgeon. We did a prospective, randomised study of 40 consecutive patients with mBCC of the face. The extent of the tumour was assessed under standard conditions by consultant surgeons and compared with assessments by resident surgeons with the help of the Varioscope, a combination of microscope and loupe glasses with strong illumination and a maximal magnification of 7x. The data from a former retrospective study of all excisions of mBCC of the face during a five-year period at the hospital served as control. Residents with the support of the Varioscope achieved a rate of incomplete excisions similar to that of consultants under standard conditions. There was a significant reduction of the rate of incomplete resections by resident surgeons thanks to high magnification and good lighting (p=0.02). High magnification and good lighting were useful in learning how to recognise skin changes associated with mBCC of the face and achieving a low rate of incomplete excisions.

Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma?

“…3,8,21,26,27 In contrast, Kumar et al 9 concluded that the incidence of incomplete excision is not related to the experience of the surgeon. 3,8,21,26,27 In contrast, Kumar et al 9 concluded that the incidence of incomplete excision is not related to the experience of the surgeon.…”

“…This can lead to significant cosmetic disfigurement, especially when the face is involved. 5,8 Incomplete excision remains a frustrating problem because it leads to a significant reoperation rate or prolonged follow-up, with concomitant patient discomfort and economic impact. 1,3Y5 A wide range of different treatments has been described for the management of BCCs, but conventional surgical excision is the treatment of choice for primary BCCs and is appropriate for most of the these tumors.…”

Incompletely Excised Basal Cell Carcinoma: Residual Tumor Rates at Mohs Re-Excision

“…17 Mixed histologic, micronodular, and morpheic subtypes are more likely to have margins involved by subclinical extension. 21 Baba and colleagues reported that Tzanck smear testing had high accuracy for margin control for well-demarcated BCC. 19 Shalom and colleagues recommend using a clinical stretch test before excision to help identify margins.…”

“…20 Erba and colleagues recommend high magnification and good lighting to enhance the ability of plastic surgeons to recognize morpheic BCC margins. 21 Baba and colleagues reported that Tzanck smear testing had high accuracy for margin control for well-demarcated BCC. 22 A meta-analysis *St John's Institute of Dermatology, St Thomas' Hospital, London, UK; † Toowoomba Eye and Skin Clinic, Toowoomba, Queensland, Australia by Rogalski and colleagues reported that incomplete excision was 2.5 times as likely on the ear or nose.…”