What Is the Best Surgical Margin for a Basal Cell Carcinoma: A Meta-Analysis of the Literature

Gulleth, Yusuf; Goldberg, Nelson H.; Silverman, Ronald P.; Gastman, Brian

doi:10.1097/prs.0b013e3181ea450d

Cited by 183 publications

(163 citation statements)

References 97 publications

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“…Excision of nodular or superficial BCC with 3-to 4-mm margins in low-risk anatomic locations was associated with 2% to 4% recurrence rates after 3 to 5 years. 35,[38][39][40] In a study comparing standard excision with C&E followed by cryosurgery for nonaggressive BCC on the head and neck, the 5-year recurrence rates were 8.2% and 17.6%, respectively. 36 Recurrence rates following surgical excision were uniformly significantly lower than those following treatment with topical therapy, radiation therapy, or destructive modalities.…”

Section: Standard Excisionmentioning

confidence: 99%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

328

219

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Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed. ( J Am Acad Dermatol

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Section: Standard Excisionmentioning

confidence: 99%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

328

219

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“…Recurrence is better defined as a persistent disease and is mainly correlated with inadequate local treatment (5)(6)(7). The use of intra-operative frozen section remains controversial in the surgical treatment of non-melanoma skin cancer, being commonly considered an optional tool, the reliability and effectiveness of which remain questionable (8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Study to determine whether intraoperative frozen section biopsy improves surgical treatment of non-melanoma skin cancer

Nicoletti

Brenta

Malovini

et al. 2012

Molecular and Clinical Oncology

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Abstract. Skin cancers are the most common types of cancer and their incidence has shown an increase of ~4 to 8% per year over the last 40 years. The majority of skin cancers (~97%) are non-melanoma skin cancers, mainly represented by basal cell (80%) and squamous cell carcinomas (20%). The use of intra-operative frozen section remains controversial in the surgical treatment of non-melanoma skin cancer, being commonly considered an optional tool, the reliability and effectiveness of which remain questionable. A large retrospective study was conducted to examine 670 surgical excisions of non-melanoma skin cancers of the head and neck in 481 patients over a period of nine years, between May, 2002 and December, 2011, at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy. Results demonstrated the paradoxical ineffectiveness of an intra-operative frozen section biopsy in pursuing higher rates of radical excision in non-melanoma skin cancers. Nevertheless, a more detailed analysis on the use of frozen sections focusing on the various anatomical sites of the body demonstrated a reverse trend in the eyelids and canthi, where a higher success rate (87.50 vs. 69.77%) in the surgical treatment of non-melanoma skin cancers was obtained with the use of an intra-operative frozen section biopsy. Results of the present study suggested that intra-operative frozen section biopsy be routinely used in the surgical treatment of nonmelanoma skin tumors involving the eyelids and canthi.

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“…Common and effective treatment options for BCC include electrodessication and curettage, surgical excision, radiation, and photodynamic therapy. 16,47,81,85 Despite a lack of high-quality evidence (CoE I), targeted systemic therapies such as vismodegib, a sonic hedgehog pathway inhibitor, may improve survival in patients with metastatic BCC. 88 …”

Section: Basal Cell Carcinomamentioning

confidence: 99%

A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases

Goodwin

Sankey

Liu

et al. 2016

SPI

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OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p < 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%–88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0.2%–100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%–33.3%). Age greater than 65 years, sacral spinal involvement, presence of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.

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What Is the Best Surgical Margin for a Basal Cell Carcinoma: A Meta-Analysis of the Literature

Abstract: A 3-mm surgical margin can be safely used for nonmorpheaform basal cell carcinoma to attain 95 percent cure rates for lesions 2 cm or smaller. A positive pathologic margin has an average recurrence rate of 27 percent.

Cited by 183 publications

References 97 publications

Guidelines of care for the management of basal cell carcinoma

Guidelines of care for the management of basal cell carcinoma

Study to determine whether intraoperative frozen section biopsy improves surgical treatment of non-melanoma skin cancer

A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases

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