Dermatoscopically narrowed surgical margins for head and neck basal cell carcinoma: A retrospective case-control study

Abstract

Background: Basal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head-and neck area, defining both radical and healthy skin sparing surgical margins is complex.

Materials and methods: Excised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical-dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences.

Results: Of 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1-2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1-2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively.

Conclusions: BCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well-defined and non-aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1-2 mm should be reserved only for BCCs in very difficult-to-treat areas, as the surgical cure rate was only 93 %.

Figure 1

Basal cell carcinoma of the nose (control, only clinically evaluated): surgical safety margins at 1.5 mm are outlined by blue dots (a). Clinically evaluated surgical margins at 1.5mm (blue dots) and surgical planning (blue full line) (b).

Figure 2

Basal cell carcinoma of the forehead (control, only clinically evaluated): surgical safety margins at 3 mm are displayed by light‐blue dots (a). Clinically evaluated surgical margins at 3 mm overwritten by surgical planning, in light‐blue full line (b).

Figure 3

Basal cell carcinoma of the nose (case): surgical safety margins at 1.5 mm were at first clinically evaluated and outlined by blue dots (a). Clinically evaluated surgical margins at 1.5 mm (blue dots) and dermatoscopically evaluated margins at 1.5 mm (blue full line) (b).

Figure 4

Preauricular basal cell carcinoma (case): surgical safety margins at 3 mm were at first clinically evaluated and displayed by black dots (a). Clinically evaluated surgical margins at 3 mm (black dots) and dermatoscopically evaluated margins at 3 mm (blue full line) (b).