Article

Factors affecting the recurrence rate of basal cell carcinoma

Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.
Acta Dermato Venereologica (Impact Factor: 4.24). 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.

Full-text

Available from: Robert Gniadecki, May 30, 2015
0 Followers
 · 
271 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reported incomplete excision rates vary widely. This study described a single center's treatment of basal cell carcinoma (BCC) and squamous cell carcinomas (SCC) of the head and neck and investigated possible causes of incomplete excision.All excised BCCs and SCCs in 2011 were included into the study. Patients were identified by the diagnostic (diagnosis-related group (DRG)) codes from DC44.0 to DC44.4. A total of 437 patients were treated for 516 skin lesions.Mean age was 71.4 years and the male–female ratio was 1.29. Incomplete tumor removal was found in 11 % of all cases. Four significant factors were identified to predict incomplete excision, including age >75 years (relative risk (RR) = 14.8 % (95 %-CI: 5.8–24.7 %)), BCC tumor size above 1.5 cm (RR = 17.1 % (95 %-CI: 3.7–28.7 %)), lack of sufficient excision margin in SCC (Head and neck BCCs, and SCCs are difficult to treat, and the need for complete tumor excision is mandatory prior to reconstruction. Our findings showed that causes of incomplete excision could be identified. With this knowledge, we are able to optimize our quality of treatment, patient satisfaction, and finally, the cost/effectiveness of our department.Level of Evidence: Level III, prognostic/risk study.
    European Journal of Plastic Surgery 03/2014; 37(3). DOI:10.1007/s00238-013-0916-2
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to compare high frequency ultrasonography (HFUS) and histpathologic assessment done by punch biopsy in order to determine depth of basal cell carcinoma (BCC), in both superficial and nodular BCCs prior to brachytherapy treatment. This study includes 20 patients with 10 superficial and 10 nodular BCCs. First, punch biopsy was done to confirm the diagnosis and to measure tumour depth (Breslow rate). Subsequently, HFUS was done to measure tumour depth to search for correlation of these two techniques. Neither clear tendency nor significance of the punch biopsy vs. HFUS depth determination is observed. Depth value differences with both modalities resulted patient dependent and then consequence of its uncertainty. Conceptually, HFUS should determine the macroscopic lesion (gross tumour volume - GTV), while punch biopsy is able to detect the microscopic extension (clinical target volume - CTV). Uncertainties of HFUS are difficult to address, while punch biopsy is done just on a small lesion section, not necessarily the deepest one. According to the results, HFUS is less accurate at very shallow depths. Nodular cases present higher depth determination differences than superficial ones. In our clinical practice, we decided to prescribe at 3 mm depth when HFUS measurements give depth lesion values smaller than this value.
    Journal of Contemporary Brachytherapy 01/2015; 6(4):356-61. DOI:10.5114/jcb.2014.47860
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context: Recurrence of basal cell carcinoma (BCC) may form a prognostic problem that couldn't be fully predicted. Although there are different clinical and histologic risk factors for BCC recurrence, few reports are available for the role of biologic markers. Aim: The aim of this study was to assess the value of Cyclooxygenase-2 (COX-2), Ezrin and Matrix metalloproteinase-9 (MMP-9) in recurrence of BCC. Settings and Design: A retrospective controlled study. Materials and Methods: Primary tumors of 22 patients who had recurrent basal cell carcinoma (R-BCC) and 22 matched controls that showed non-recurrent basal cell carcinoma (NR-BCC) were collected. Clinical, histopathological, and immunohistochemical results were recorded and analyzed. Statistical analysis used: SPSS software version 13 and Pearson χ2 test. Results: R-BCC showed COX-2 expression in 20 (90.9%) cases compared to 13 (59.1%) in NR-BCC with a significant difference (P = 0.04). Moderate to strong intensity was recorded in 13 recurrent and two non-recurrent tumors. Higher frequency for Ezrin immunopositivity was noted in R-BCC (72.7%) than NR-BCC (40.9%), but the difference did not reach the level of significance (P = 0.07). Twelve R-BCC and three NR-BCC revealed moderate to strong staining. For MMP-9, there was no statistically significant difference (P = 1) between recurrent cases (63.6%) and controls (68.2%). No correlation was found between marker expressions and clinical or histologic features of R-BCC. Conclusions: Biologic markers may have a promising role in assessment of BCC prognosis and early detection of recurrence. High COX-2 expression could be considered as a risk factor of BCC recurrence that can be added to other clinical and histologic factors.
    Journal of cancer research and therapeutics 10/2013; 9(4):613-7. DOI:10.4103/0973-1482.126456 · 0.95 Impact Factor