Basal cell carcinoma of the head and neck region in ethnic chinese

Abstract

Objectives. This study aims to report our experience in the management of HNBCC in ethnic Chinese over a 10-year period. Methods. A retrospective review of all ethnic Chinese patients with HNBCC treated in a tertiary centre from 1999 to 2009. Results. From 1999 to 2009, 225 patients underwent surgical excision for HNBCC. Majority were elderly female patients. Commonest presentation was a pigmented (76.2%) ulcer (64.8%) over the nose (31.6%). Median skin margin taken on tumour excision was 2.0 mm; primary skin closure was achieved in 51.8%. Postresection skin margin was clear in 75.4%. Of those with inadequate skin margins, 56.7% opted for further treatment, 43.4% for observation. Recurrence rates were 2.6% and 13.8%, respectively (P = 0.106). Overall recurrence rate was 5.5%. Conclusions. HNBCC commonly presented as pigmented ulcers over the nose of elderly female patients in our locality. Adequate tumour excision ± reconstruction offered the best chance of cure. Reexcision of those with inadequate skin margins improved local tumour control.

Figure 1

Common presentation of HNBCC in ethnic Chinese: pigmented lesion with well-defined borders, rolled ulcer edges, central pearly area, and overlying telangiectasia.

Figure 2

HNBCC presentation—anatomical sites. The commonest site was on the nose.

Figure 3

Methods of wound closure. From right to left in a clockwise direction: an 80-year-old lady with a pigmented ulcerative BCC over her left cheek, pathology excised with a 2 mm margins, wound closed primarily; a 60-year-old lady with a pigmented ulcerative BCC over her right preauricular region, the wound was too extensive for primary closure after tumour resection, and yet there was insufficient tissue for local flap reconstruction, hence a full thickness skin graft was harvested from the postauricular region for wound coverage; a 70-year-old lady with a nonpigmented nodular BCC over her nose tip. Excision was performed with a 2 mm margin followed by reconstruction with a bilobed flap; a 50-year-old lady who presented with a pigmented ulcerative BCC over her right auricle which invaded into the superficial and deep lobes of the parotid gland; facial nerve was intact. Wide local excision of tumour with total conservative parotidectomy was performed. The defect was reconstructed with a free anterolateral thigh myocutaneous flap.

Figure 4

Treatment outcome—the greater the skin margin taken on tumour excision, the better the tumour clearance rate.

Figure 5

Management of patients with involved and close margins and associated recurrence rates.

Figure 6

Treatment outcomes of patients who chose to undergo further treatment versus observation in those with inadequate margins.

Figure 7

A graph depicting tumour recurrence over time.