The significance of incomplete excision in patients with basal cell carcinoma

Richmond, J.; Davie, Ryann

doi:10.1016/0007-1226(87)90013-0

Cited by 132 publications

(101 citation statements)

References 9 publications

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“…In the present study this situation occurred in 52 (65%) out of 80 BCCs with positive lateral margins and in 23 (55%) of the lesions presenting infiltration of a deep margin. Most previous studies have reported similar observations, and many research groups agree that the peak time of recurrence occurs during the second year following excision (13,17,29). The followup of patients in our study was for a minimum of 3 years, a likely sufficient time period during which to observe clinical manifestations of recurrence according to the literature.…”

Section: Discussionsupporting

confidence: 77%

“…Moreover, recurrence rates reported for primary BCCs 5 years after complete excision account for 99% of cases of Mohs microsurgery, about 95% for traditional surgical excision, radiotherapy or cryosurgery and almost 92% with DTC (16). Conversely, the recurrence rate for incompletely excised BCC varies from 10 to 67% (12,13,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Notwithstanding, the great disparity and variability in recurrence rates reported by different authors have contributed to the lack of an accepted Facial basal cell carcinoma: Analysis of recurrence and follow-up strategies agreement concerning the optimal therapeutic strategy to adopt in those cases in which histological examination shows an infiltration of surgical margins or a suboptimal margin free from disease.…”

Section: Introductionmentioning

confidence: 99%

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Facial basal cell carcinoma: Analysis of recurrence and follow-up strategies

Sartore

Lancerotto²,

Salmaso³

et al. 2011

Oncol Rep

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Abstract. Rates of recurrence after incomplete surgical excision of basal cell carcinoma (BCC) range from 4 to 16.6% of analyzed cases. The aim of the present study was to identify the predictive factors associated with facial BBC recurrence following excision and their influences, in order to establish a proper therapeutic strategy. A monocentric retrospective study was performed reviewing all BCCs surgically excised at the Institute of Plastic Surgery, University of Padua, with particular focus on the involvement of surgical margins and recurrence. Seven hundred and nineteen lesions in 605 patients were studied. Correlations between recurrence probability and various characteristics of BCC were analyzed using a logistic regression model. It was observed that incomplete excision, deep margin involvement, the presence of sclerodermiform or metatypic basaloid squamous cells, as well as pleomorphous histological variants and/or peritumoral inflammatory infiltrates, were all related to an increase in the probability of recurrence. BCC excision must be followed by individualized management with particular consideration for the localization, the histological type and other known predisposing factors; the treatment strategy and, in particular, the length of the surveillance period and the frequency of patient assessment should be evaluated on the basis of the recurrence probability outlined.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Facial basal cell carcinoma: Analysis of recurrence and follow-up strategies

Sartore

Lancerotto²,

Salmaso³

et al. 2011

Oncol Rep

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“…In contrast to radiotherapy, a histological appraisal of the efficiency of the treatment is possible with surgery. When an incomplete resection is diagnosed based on the embedded section, additional treatment or vigilant observation should be discussed with each patient, because recurrence occurs in only 25-50% of the cases and further treatment may prove difficult for physical or psychological reasons (Richmond and Davie, 1987;Liu et al, 1991;Preston and Stern, 1992). The frozen section examination, which assesses immediately the quality of the resection, avoids this problem and allows complete resection with a single surgical procedure in most cases.…”

Section: Failure Ratementioning

confidence: 99%

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

Avril

Aupérin²,

Margulis³

et al. 1997

Br J Cancer

298

175

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Summary Basal cell carcinomas (BCCs) are very frequent cutaneous cancers, often located on the face. Cure rates with surgery and radiotherapy are high, but these treatments have never been compared prospectively. A randomized trial was initiated in 1982 to compare surgery and radiotherapy in the treatment of primary BCC of the face measuring less than 4 cm. The primary end point was the failure rate (persistent or recurrent disease) after 4 years of follow-up. The secondary end point was the cosmetic results assessed by the patient, the dermatologist and three persons not involved in the trial. In the course of the trial, 347 patients were treated. Of the 174 patients in the surgery group, 71% had local anaesthesia and 91% frozen section examination. Of the 173 patients in the radiotherapy group, 55% were treated with interstitial brachytherapy, 33% with contactherapy and 12% with conventional radiotherapy. The 4-year actuarial failure rate (95% Cl) was 0.7% (0.1-3.9%) in the surgery group compared with 7.5% (4.2-13.1%) in the radiotherapy group (log-rank P= 0.003). The cosmetic results assessed by four of the five judges were significantly better after surgery than after radiotherapy. Eighty-seven per cent of the surgery-treated patients and 69% of the radiation-treated patients considered the cosmetic result as good (P < 0.01). Thus, in the treatment of BCC of the face of less than 4 cm in diameter, surgery should be preferred to radiotherapy.

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“…Studies using approximately 2-5 years of follow up have reported recurrence rates following histologically incomplete excision of 38%, (Richmond & Davie, 1987) and 41% (De Silva & Dellon, 1985). Patients should undergo re-treatment of incompletely excised lesions especially when they involve critical midfacial sites, where the deep surgical margin is involved, the surgical defect has been repaired using skin flaps or skin grafts and where histology shows an aggressive histological subtype (Mackie & Quinn, 2004).…”

Section: Special Management Issues 9101 Incompletely Excised Basal mentioning

confidence: 99%