Margin positive basal cell carcinoma – 10 years retrospective analysis
Journal Title: Medpulse International Journal of Surgery - Year 2019, Vol 9, Issue 1
Abstract
Background: Basal cell carcinoma (BCC) is a locally invasive malignant tumor. Incidence is increasing by 10% per year; incidence of metastases is minimal, but local recurrence is common. The complete excision of the BCC allows reduction of relapse. Materials and Methods: Retrospective data was collected from hospital data base of the patients who were diagnosed to have BCC and underwent surgery during period of January 2006 to December 2015. The patient and tumor character’ son age, primary site of tumor, tumor size, surgery and reconstruction done, pathologic diagnosis, marginal status, adjuvant therapy, recurrence and disease status at last follow-up were noted. Results: Total of 73 patients were treated during study period. All patients underwent wide local excision. Three patients underwent orbital exentration, who had tumor around eye and was infiltrating conjunctiva/cornea. Margins were focally positive in 19 patients. These patients were not submitted for reexcision and were on follow up. Margins were free in 54 patients with average margin of 2.1 mm (range 1 mm –5 mm). Four patients received adjuvant radiation as one patient had twice recurrence, two patients had gross positive margin and other patient had perineural invasion. At a median follow up of 27 months (range, 1 to 71 months), 46 patients are on follow up. Five (10.9%) patients had recurrence. Four of five patients had focally positive margin on histopathology at initial surgery, one patient had free margin of 2mm during initial surgery. Reexcision was done in all patients with advant radiation therapy in one patient who presented with twice recurrence. Twenty seven patients were lost to follow up. Of 19 patients, histopathology report showing focally positive margins, four (21 %) patients recurred at a median follow up of 22.6 months (range, 12 – 36 months). Conclusion: Basal cell carcinoma is locally invasive malignant tumor with indolent course. Wide excision with adequate margin is the treatment of choice. Even with focally positive microscopic margin, chance of recurrence is around 23% on long term follow up, and should be managed surgically when detected, in centers where frozen section is not routinely practiced.
Authors and Affiliations
Siddappa K Thammaiah, Santosh Ijeri
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