What Is the Best Surgical Margin for a Basal Cell Carcinoma: A Meta-Analysis of the Literature

University of Maryland, Baltimore, Baltimore, Maryland, United States
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 10/2010; 126(4):1222-31. DOI: 10.1097/PRS.0b013e3181ea450d
Source: PubMed


Current management of basal cell carcinoma is surgical excision. Most resections use predetermined surgical margins. The basis of ideal resection margins is almost completely from retrospective data and mainly from small case series. This article presents a systematic analysis from a large pool of data to provide a better basis of determining ideal surgical margin.
A systematic analysis was performed on data from 89 articles from a larger group of 973 articles selected from the PubMed database. Relevant inclusion and exclusion criteria were applied to all articles reviewed and the data were entered into a database for statistical analysis.
The total number of lesions analyzed was 16,066; size ranged from 3 to 30 mm (mean, 11.7 ± 5.9 mm). Surgical margins ranged from 1 to 10 mm (mean, 3.9 ± 1.4 mm). Negative surgical margins ranged 45 to 100 percent (mean, 86 ± 12 percent). Recurrence rates for 5-, 4-, 3-, and 2-mm surgical margins were 0.39, 1.62, 2.56, and 3.96 percent, respectively. Pooled data for incompletely excised margins have an average recurrence rate of 27 percent.
A 3-mm surgical margin can be safely used for nonmorpheaform basal cell carcinoma to attain 95 percent cure rates for lesions 2 cm or smaller. A positive pathologic margin has an average recurrence rate of 27 percent.

Download full-text


Available from: Ronald P Silverman, Oct 03, 2015
313 Reads
  • Source
    • "Squamous cell carcinoma (SCC) [45] [46] [36] [47] [37] Guidelines for MMS in SCC reflect the differences in access to the technique in different countries [48] [49] [50] [51] [52] (level of evidence 1). Guidelines on MMS indications vary widely between different scientific societies: BAD, NCCN, NHMRC, NCI, GSC/GDS [49] [50] [51] [52]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection. Copyright © 2014. Published by Elsevier Masson SAS.
    European Annals of Otorhinolaryngology, Head and Neck Diseases 11/2014; 131(6):375-383. DOI:10.1016/j.anorl.2014.06.002 · 0.82 Impact Factor
  • Source
    • "It is the first line therapeutic method. The excision performs with 3-10 mm margins outside the tumor, depending on the size and localization of the carcinoma.[11] The results of 5-year follow-up after the surgical treatment of BCC with up to 1.5 cm diameter size of the primary tumor show the recurrences in 12% of the cases, while in primary carcinomas with sizes above 3 cm diameter the recurrence rate is 23%.[12] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Basal cell carcinoma (BCC) is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.5% of the cases; however, a considerable local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is made according to Tumor, Node, Metastasis (TNM) classification and is essential for performing the adequate treatment. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis. Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not be underestimated.
    01/2013; 4(1):12-17. DOI:10.4103/2229-5178.105456
  • Source
    • "Although the incidence of metastases is minimal, relapses are, in the other hand, very frequent; indeed, an estimated 40%–50% of patients with a primary carcinoma will develop at least one or more further basal-cell carcinomas within 5 years [7]. According to a meta-analysis of 16,066 cases, recurrence rates for 5 mm, 4 mm, 3 mm, and 2 mm surgical margins were 0.39, 1.62, 2.56, and 3.96 percent, respectively [8]. Mohs technique recurrence rate is 4,5% in five years [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Basal cell carcinoma (BCC) is a locally invasive malignant epidermal tumour. Incidence is increasing by 10% per year; incidence of metastases is minimal, but relapses are frequent (40%-50%). The complete excision of the BCC allows reduction of relapse. Materials and Methods. The study cohort consists of 1123 patients underwent surgery for basal cell carcinoma between 1999 and 2009. Patient and tumor characteristics recorded are: age; gender; localization (head and neck, trunk, and upper and lower extremities), tumor size, excisional margins adopted, and relapses. Results. The study considered a group of 1123 patients affected by basal cell carcinoma. Relapses occurred in 30 cases (2,67%), 27 out of 30 relapses occurred in noble areas, where peripheral margin was <3 mm. Incompletely excised basal cell carcinoma occurred in 21 patients (1,87%) and were treated with an additional excision. Discussion. Although guidelines indicate 3 mm peripheral margin of excision in BCC <2 cm, in our experience, a margin of less than 5 mm results in a high risk of incomplete excisions.
    01/2011; 2011(5):476362. DOI:10.1155/2011/476362
Show more