Do basal cell carcinomas recur after complete conventional surgical excision?

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Summary

For 1378 patients treated in the 11 years 1988–1998 by conventional excision of 1635 basal cell carcinomas, 1516 first index lesions were histologically completely excised.

All patients having more than one BCC excised were identified from the data base from 1988 to 2003 to give minimum 5 years follow for last treated primary lesions in 1998. Measured clearance margins around the initial lesions at or near sites of presumptive recurrent lesions were noted and the lesions recorded photographically. All incompletely excised lesions whether or not re-excised were excluded.

The median age for all patients was 70 years. Over minimum 5 years follow up, six patients developed nine subsequent lesions contiguous with the scar or graft repair of primary index lesion excision site (probable recurrences). The median interval to recurrence was 41 months (4 months–8 years 10 months), with median lateral clearance margin around the primary tumour of 2 mm (0.3–6.8 mm).

A further nine patients developed 11 new lesions near (within 1 cm of) the scar or graft of primary index lesion excision site (possible recurrences). The median interval to recurrence was 59 months (1 year–8 years 6 months). The median lateral clearance margin around the primary tumour was 4.1 mm (0.8–5.8 mm). For the two groups combined the maximum recurrence rate expressed as a percentage of index lesions was 1.3% (20/1516). Two thirds of possible and probable recurrences occurred in the temple and forehead, although these sites represented only 22% of all lesions, which may rather suggest new lesions in an area of field change as opposed to residual disease.

The measured clearance margins reported here perhaps suggest that some original lesions may well have been completely excised primarily and many ‘recurrences’ were new primaries.

These figures indicate there is a low order of probability for the incidence of recurrent basal cell carcinoma during minimum 5 years follow period after conventional surgical excision and conventional histological assessment of tumour resection margins.

Section snippets

Material and methods

The data base of consecutive patients having basal cell carcinomas excised under the care of one consultant for the 11 years from 1988 to 1998 was studied. The total number of patients and total number of lesions were noted. All first lesions treated in the period were designated index lesions. Second lesions identified either in the 1988–1998 period or subsequent 5 years 1999–2003 were studied to determine if they could reasonably be considered from their position, to represent possible or

Results

In the period 1988–1998 (11 years) 1378 patients (median age 70 years) were treated with conventional surgical excision for 1635 first index basal cell carcinomas. One hundred and nineteen (7%) were reported as incompletely excised and the policy was to re-excise these. In practice 91/119 (76%) were re-excised with residual tumour found in 48/91 (53%).

Discussion

Despite the theoretical advantage of more extensive histological assessment of excision margins for BCC with Mohs' micrographic surgery, the 5 years recurrence rates for BCC after complete excision by either Mohs' surgery or conventional surgery are similar in the range 0.35–2.6%.1, 2, 3, 4, 5, 13, 14 These publications contain little information on the nature or definition of the local recurrences, however. Specifically, local recurrence is not consistently or uniformly defined, nor are index

Acknowledgements

We are delighted to thank Robert Salthouse for his hard work in preparing the colour illustrations to such a high standard.

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