Facial basal cell carcinoma: a clinicopathological analysis of incomplete excision

Basal cell carcinoma (BCC) is the most common malignancy in humans. Incomplete excision following conventional surgical excision requires careful consideration given the potential for disease recurrence. We performed a retrospective study analyzing facial BCC treated by conventional surgical excision to investigate factors influencing the likelihood of tumour clearance. In total, 456 cases of facial BCC were reviewed to collect a dataset of 50 tumours with involved margins and these compared to 50 completely excised tumours from the same cohort. Statistical comparison between incomplete and complete excision cases was performed using several metrics including tumour location, histology, grade, surgeon experience and method of wound reconstruction. Interestingly, our results demonstrated that only tumour location and histological type had a statistically significant impact on the completeness of resection. Infiltrative, morphoeic and mixed tumours had a higher chance of incomplete excision, as did tumours located on the inner canthus and ala nasi. In addition, the overall incomplete excision rate was 10.96% in line with previous studies. Our results help inform surgical practice and support consideration of extending the recommended macroscopic surgical margin for higher risk tumours. More research is needed to further categorize facial BCC to optimize surgical management.

Mucosal Invasion, but Not Incomplete Excision, Has Negative Impact on Long-Term Survival in Patients With Extramammary Paget’s Disease

BackgroundExtramammary Paget’s disease (EMPD) sometimes spreads from the skin to mucosal areas, and curative surgical excision of these areas is challenging. The aim of this study is to analyze the impact of mucosal involvement and surgical treatment on the survival of patients with EMPD.MethodsWe conducted a retrospective review of 217 patients with EMPD. We also assessed the associations between tumor involvement in boundary areas (anal canal, external urethral meatus, vaginal introitus), prognostic factors, and survival in 198 patients treated with curative surgery.ResultsOf 217 patients, 75 (34.6%) had mucosal boundary area involvement. Lesions in these areas were associated with frequent lymphovascular invasion (p = 0.042), lymph node metastasis (p = 0.0002), incomplete excision (p < 0.0001), and locoregional recurrence (p < 0.0001). Boundary area involvement was an independent prognostic factor associated with disease-specific survival, per multivariate analysis (HR: 11.87, p = 0.027). Incomplete excision was not significantly correlated with disease-specific survival (HR: 1.05, p = 0.96).ConclusionBoundary area tumor involvement was a major risk factor for incomplete excision, local recurrence, and poor survival outcomes. However, incomplete removal of primary tumors was not significantly associated with poor prognosis. A less invasive surgical approach for preserving anogenital and urinary functions may be acceptable as the first-line treatment for resectable EMPD.

Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Background: One common treatment for Bowen’s disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins. Objectives: This study examined what factors affect the rate of incomplete excision of BD. Methods: Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin). Results: In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition. Conclusions: When removing BD surgically, an elliptical excision with surgical margins ≥3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.

A retrospective study to assess the influence of anaesthetic type on incomplete excision rate for non-melanoma skin cancers

Background: Australia has the highest incidence of non-melanoma skin cancers (NMSC) in the world estimated to be 2448/100,000 population with the state of Queensland carrying the highest burden of disease. Surgical excision is the primary treatment and makes up a large proportion of general surgical lists in regional Queensland where they are typically removed using either local anaesthetic (LA) alone, local anaesthetic and sedation (LAS), or general anaesthesia (GA). There is little in the literature to suggest if anaesthetic type effects the rate of incomplete excision. The purpose of this study is to establish if anaesthetic type impacts the rate of incomplete excision of NMSC.Methods: A retrospective audit was performed, incorporating a total of 194 squamous and basal cell carcinoma lesions excised between October 2019 and October 2020 at two hospitals in regional Queensland, Australia. Data was recorded for the type of anaesthetic used and the histopathology of the lesions including type of lesion and clearance of microscopic margins.Results: Of the 194 excised lesions 39 of them had involved margins (20.1%). The rate of involved margins under LA, GA and LAS were found to be 19.79, 18.52 and 22.73% respectively. When comparing these modalities with each other: LA vs. GA, LAS vs. GA and LA vs. LAS no significant difference was found in the rate of incomplete excision of NMSC with p values (<0.05) of 1, 0.62 and 0.82 respectively.Conclusions: Modality of anaesthetic used for excision of NMSC does not affect the outcome of incomplete excision of NMSC.

A multicentre review of the histology of 1012 periocular basal cell carcinomas

Aims: To evaluate primary periocular basal cell carcinomas (BCCs) in depth including comparing histological margins with subtype, location and surgical specialty after wide local excision. Methods: A retrospective review was performed for all BCCs excised from three hospitals over 5 years, covering a population of just over 1 million. Tumours were classified according to histological subtype location. Incomplete excision rates and margins were analysed in detail and comparisons made. Results: The most common subtype found was nodular followed by infiltrative. Lesions were most commonly located at the lower lid. Infiltrative BCCs were associated with perineural invasion and incomplete excision despite the largest peripheral margins. Superficial BCCs had the smallest mean peripheral margin but the largest mean deep margin. 2 mm histological margins gave an 83.7% complete excision rate, 6.4% incomplete excision rate and 7.1% where the clearance margin was 0.3 mm or less. Conclusion: Distribution of eyelid BCCs based on subtype and periocular location mirrored the general consensus. Infiltrative BCCs should be excised with wider margins or referred for Mohs surgery, especially if the medial canthus is involved. Superficial BCCs should be excised with wider but shallower surgical margins. Ophthalmologists were more likely than dermatologists or plastic surgeons to incompletely excise a periocular BCC, which is reflective of their more difficult case mix.