Surgical Excision of Non–Melanoma Skin Cancer in an Elderly Veteran’s Affairs Population

Abstract

Background:Non–melanoma skin cancer (NMSC) is the most common malignancy in the United States. Recommended treatment for NMSC remains surgical excision following a positive biopsy. Evidence of complete spontaneous regression of residual NMSC exists in the case of small lesions macroscopically removed by shave biopsy, but with a positive microscopic margin. The present study investigates the rate at which residual tumor is present at subsequent excisional biopsy, with the aim to assess if recommendation to forgo surgical excision can be made.Methods:A total of 233 shave biopsies of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) were performed during a 5-year period. All specimens included in the study were less than 2 cm in diameter, were macroscopically removed by shave biopsy, and had a positive initial microscopic margin.Results:On subsequent surgical excisional biopsy, 42% of BCC specimens were negative for residual tumor, 38% had residual tumor, but the tumor was completely contained in the excised specimen, and 20% of the specimens had positive margin residual tumor. For SCC specimens, 73% were negative for residual tumor, 21% had residual tumor, but the tumor was completely contained in the excised specimen, and 6% of the specimens had positive margin residual tumor.Conclusions:Although reduction of residual tumor at reexcision is noted with both BCC and even more so with SCC, the rate at which this occurs is not sufficient that a general recommendation to forgo surgical excision can be made.

Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature

“…Stewart et al 49 assessed elderly patients with KCs thought to be small enough for complete removal by shave biopsy. Examination of the surgical specimens taken after shave biopsy showed that 42% of the BCC specimens and 73% of the cSCC specimens were negative for residual tumour.…”

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

“…The current literature suggests that the treating physician’s specialty could also affect the technique utilized. For example, while some dermatology articles suggest that tangential shave removal of certain lesions provides an acceptable cure rate, Stewart et al found an unacceptably high rate of residual BCC and SCC after shave biopsies [ 114 , 116 ]. This reflects the controversy surrounding type of biopsy employed previously in this article.…”

Analysis of Cases in Which a Biopsy Specimen Is Positive and an Excised Lesion Is Negative for Nonmelanoma Skin Cancer

“…Oftentimes, no residual carcinoma is detected, implying spontaneous clearance at rates reported to vary from 24% to 76%. [2][3][4][5] These types of lesions have been investigated by others 2-5 and are not fully understood. Our study aims to determine the lesion and patient characteristics that would most strongly predict a histologically negative result for an excised lesion after a biopsy specimen had positive margins.…”

“…However, generalizability of these outcomes to underserved patients may be hindered by unrecognized barriers. 2 The aim of this study was to identify patient-reported barriers to successful implementation of a preoperative risk-reduction program at a safety-net hospital.…”