Factors affecting the recurrence rate of basal cell carcinoma.

Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.
Acta Dermato Venereologica (Impact Factor: 3.49). 01/2007; 87(4):330-4. DOI: 10.2340/00015555-0236
Source: PubMed

ABSTRACT The aim of this retrospective survey was to determine recurrence rates after treatment of basal cell carcinomas in a single academic dermatology department. A total of 1016 patients with 1593 histologically verified basal cell carcinomas (n=1212 primary and n=381 relapsing) were included. Tumour localization, T-stage and the method of treatment were significant predictors of the risk of recurrence (forward Cox regression, p <0.001). The relapse rate for primary basal cell carcinomas on the scalp was highest (odds ratio (OR)=2.8, 95% confidence interval (CI) 1.5-5.3). T2 and T3 tumours showed a 2- and 3-fold increased relapse rate, respectively, compared with T1 basal cell carcinomas. Radiotherapy and surgical excision had the lowest relapse rates, whereas curettage and photodynamic therapy resulted in 5-year relapse rates of up to 70%. Patients with chronic skin diseases had a 50% lower risk of relapse than healthy patients (OR=0.5, CI=0.3-0.8). Recurrent basal cell carcinomas had a higher relapse rate than primary lesions (OR=1.8, CI=1.4-2.2). Patients treated in a specialized skin cancer unit had a 6.4-fold (CI=2.4-17.4) higher cure rate compared with those treated by less experienced physicians. Thus, in an uncontrolled, real-life situation curettage or photodynamic therapy are associated with significantly higher relapse risk than excision and radiotherapy and therefore should not be used for high risk primary tumours or recurrent tumours. Treatment in the setting of a specialized skin cancer unit yields a much lower relapse rate.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several differences in basal cell carcinomas (BCCs) were found, according to the ethnic group; for example, pigmented BCCs was more common in Asian or Hispanic patients. However, there are few reports on the subclinical extension of the BCC in Asian patients. The aim of this study was to evaluate the subclinical infiltration of the basal cell carcinoma in Asian patients. All patients with BCC who visited the department of dermatology at Korea University Ansan Hospital were treated with Mohs micrographic surgery. In 81 patients, 83 tumors of BCC were completely eradicated by Mohs micrographic surgery (MMS) from April 2001 to August 2008, and were reviewed in this study. Information recorded included the total margin and the number of stages of Mohs micrographic surgery, anatomic location, tumor size, presence of pigmentation, clinical type, and pathological subtype. We divided the clinical types into nodular, ulcerated, and pigmented, and the pathological types into nodular, micronodular, morpheaform, and adenoid. The BCC was of pigmented type if pigmentation covered more than 25% of the tumor, regardless of whether pigmentation was distinct, or if there was apparent pigmentation that covered more than 10% of the tumor. The nose and cheek were the most common sites requiring more than one stage of surgery. In tumors smaller than 1 cm, 91.7% required only one stage of excision, compared with 60.6% in tumors larger than 1 cm. More than two Mohs stages were required in 25% of non-ulcerated BCCs and in 46.2% of ulcerated BCCs. Sixty eight percent of pigmented BCCs required only one stage of Mohs micrographic surgery. In cases of non-pigmented BCCs, only 45% required one Mohs stage. More than one Mohs stage was required in 19.2% of non-aggressive BCCs and in 42.9% of aggressive BCCs. Subclinical infiltration differed between the two groups according to the size of the BCC (1 cm threshold) and most of the BCCs were located in the head and neck area. Considering this result, indication for MMS can be extended for BCCs larger than 1 cm in Asian patients. Ulcerated BCCs required more Mohs stages than non-ulcerated BCCs. Pigmented BCCs might show lesser subclinical infiltration than non-pigmented BCCs. Aggressive pathological subtypes showed more subclinical infiltration than the non-aggressive types; however, after evaluation of the border that was excised with MMS, mixed histologic types were found to be more frequent than generally accepted. Therefore, we consider that, when planning surgery, dermatologists should not place too much confidence in the pathologic subtypes identified by biopsy.
    Annals of Dermatology 08/2011; 23(3):276-81. · 0.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Basal and squamous cell carcinomas are the most common non-melanoma skin cancers (NMSC) in humans. Their prevalence is higher in immunocompromized patients. Results of some animal experiments have indicated that TNF acts both as a tumour promotor and an inductor of apoptosis. AREAS COVERED: Peer-reviewed articles about human skin cancers possibly related to TNF antagonists. The occurrence and growth kinetics of NMSC are possibly increased in some patients under TNF antagonist therapy. Other issues of such biological treatment suggested include the activation of other distinct skin malignancies, including malignant melanoma. Benign melanocytic tumours appear to be boosted as well. At present, most of the reported findings only represent anecdotal case reports. The influence of cumulative co-factors must not be neglected, particularly the effect of other therapies administered to the patients. The occurrence of antibodies to some TNF antagonists may decrease both the treatment efficacy and the risk of skin cancer progression. EXPERT OPINION: More research needs to be performed in order to firmly establish and understand the risk of anti-TNF biologicals in the area of human skin cancers. At present, NMSC progression appears to be boosted on areas of skin field cancerization. Benign melanocytic naevi may develop as well.
    Expert opinion on biological therapy 09/2011; 11(9):1215-22. · 3.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Incomplete or suboptimal surgical excision of basal cell carcinoma of the head and neck is a relatively frequent occurrence. Methods of preoperative assessment of tumoral margins are therefore of paramount importance. The aim of this study was to compare the preoperative evaluation of margins with digital dermoscopy and clinical definition. One hundred and 12 patients with histologically confirmed basal cell carcinoma were selected for surgical excision. Subsequently, the margin of excision was determined by either clinical (45 patients) or dermoscopic evaluation (67 patients). After pre-surgical clinical evaluation, 22% of histological specimens of excised basal cell carcinoma showed suboptimal margins of excision. Pre-surgical dermoscopic evaluation had only 7% suboptimal excision. Preoperative digital dermoscopy is a better method to determine tumoral margins than clinical evaluation alone. Indeed, preoperative digital dermoscopy is an effective, simple, non-invasive procedure for the pre-surgical determination of margins.
    The Journal of Dermatology 12/2011; 39(4):326-30. · 1.77 Impact Factor

Full-text (2 Sources)

Available from
May 15, 2014