Incompletely excised basal cell carcinomas: Our guidelines

P Longhi, M Paola Serra, E Robotti

Department of Plastic and Reconstructive Surgery “Ospedali Riuniti di Bergamo”, Bergamo, Italy

Abstract: A retrospective review of 982 patients treated for basal cell carcinoma (BCC) was conducted over a period of 8 years from 1996 to 2004. Of these patients, 16 presented a margin involvement. Two cohorts of patients with involved margin were identified: the group whose basal cell carcinoma was re-excised, and the “wait and see” group. Both sets of results obtained were compared, and then matched with recent international literature reviews. Re-excision is our current practice for incompletely excised tumor. However during the period examined only 36 patients of 116 with margin involvement, proceeded to re-excision, and of the remaining 80 patients just 39 were followed-up. The others were missed mainly because of the difficulty of attending follow-up consultations because of advanced age, poor general conditions, and unavailability of transport facilities. On the basis of several points, including a high number of residual tumors detected in the re-excised patients, and difficulty in maintaining diligent follow-up in the “wait and see” group, we stress the importance of considering an early re-excision in case of margin involvement (focal, lateral, or deep), to avoid a significant risk of recurrence. In this study 16 patients out of 39 in the “wait and see” group had recurrences over 8 years of follow-up; a significant number of recurrences was observed after 5 years. We therefore reserve a clinical follow-up only for patients in whom poor general health dissuades us from re-operation.

Keywords: basal cell carcinoma, excise, guidelines, tumor