The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma

Bieley, Harlan C.; Kirsner, Robert S.; Reyes, Blas A.; Garland, Larry D.

doi:10.1016/0190-9622(92)70106-p

Cited by 58 publications

(39 citation statements)

References 9 publications

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“…By frozen section analysis with MMS of 77 patients with incomplete excision of BCC of the face, 55% had residual tumor present. 22 Tissue sectioning with MMS allowed greater analysis of tissue margins than the usual pathological preparation of 2-mm serial sections perpendicular to the long axis. Another reason that clinical recurrence did not occur in the earlier studies might be that tumor present at the margin was devitalized during the surgical procedure, eg, by electrocautery, and disappeared after surgery.…”

Section: Commentmentioning

confidence: 99%

Recurrent Basal Cell Carcinoma After Incomplete Resection

Robinson¹,

Fisher²

2000

Arch Dermatol

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Section: Commentmentioning

confidence: 99%

Recurrent Basal Cell Carcinoma After Incomplete Resection

Robinson¹,

Fisher²

2000

Arch Dermatol

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“…Unnoticeable extension means that visual estimates of tumor perimeters may be insufficient and that inadequate removal may result. 2,5 Any residual tumor left after treatment greatly increases the likelihood of clinical recurrence. [6][7][8] Because malignant extensions often are not clinically detectable due to the microscopic nature of tumor spread, complete tumor excision relies on microscopic tissue margin control.…”

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confidence: 99%

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Batra¹

2002

Arch Dermatol

160

130

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Background: In nonmelanoma skin cancer, the clinically visible portion may represent a small fraction of microscopic tumor spread. Previous studies have examined individual risk factors for subclinical spread based on patient and tumor characteristics. However, these risk factors have not been prioritized or studied in combination.Objective: To identify the most predictive risk factors for extensive subclinical tumor spread.Design: Retrospective analysis of 1131 Mohs micrographic surgical cases. Variables analyzed included patient age, sex, and immune status and lesion size, location, histologic subtype, and recurrence. Logistic regression was applied to identify important combinations of tumor characteristics and to quantify relative odds of spread.Setting: Academic referral center.Patients: Consecutive sample of all referred patients treated by a single Mohs micrographic surgeon in a 3-year period.Main Outcome Measure: Number of Mohs micrographic surgical layers required to clear a tumor, with 3 or more layers defined as extensive subclinical spread.Results: The highest-risk tumors, with odds ratios greater than 6.0, were basosquamous and morpheaform basal cell carcinoma (BCC) on the nose, morpheaform BCC on the cheek, and those with a preoperative size greater than 25 mm. Other important risk factors were recurrent and nodular BCC on the nose; location on the eyelid, temple, or ear helix; neck tumors and recurrent BCC in men; and tumor size greater than 10 mm. Patients younger than 35 years were at lower risk. Increasing age and immunocompromise were not significant predictors. Conclusion:Identification of lesions likely to exhibit extensive subclinical spread can help guide management to ensure complete tumor eradication and thereby reduce the risk of recurrence and its associated morbidity and cost.

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“…Regarding surgical excision, a 38.5% recurrence was noted when histological analysis showed an infiltration (lateral, deep or both margins infiltration), while a 25.5% recurrence rate for lesions with suboptimal excision can be expected and a 8.4% recurrence with histologically confirmed optimal excision, nevertheless, was recorded during the follow-up. According to some investigators this fact may be explained considering that standard histological procedures may lead to an inaccurate analysis of a percentage of tissue samples (26,28). Moreover, a further explanation may be found in the predisposition of the individual patient to develop skin neoplasms, and the recurrence may actually be the macroscopic clinical manifestation of a newly developed BCC or a lesion already present nearby the primary lesion.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma

Cited by 58 publications

References 9 publications

Recurrent Basal Cell Carcinoma After Incomplete Resection

Recurrent Basal Cell Carcinoma After Incomplete Resection

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

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

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