Five-Year Risk of Basal Cell Carcinoma Recurrence After a Conventional Surgical Excision

  • Bruno Duarte Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal http://orcid.org/0000-0003-4757-0679
  • Luis Vieira Plastic and Reconstructive Surgery Department, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal http://orcid.org/0000-0002-9353-2537
  • Luis Ribeiro Plastic and Reconstructive Surgery Department, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  • Tomás Pessoa e Costa Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  • Alexandre João Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  • Alice Varanda Plastic and Reconstructive Surgery Department, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  • Joana Cabete Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
Keywords: Carcinoma, Basal Cell, Dermatologic Surgical Procedures, Skin Neoplasms

Abstract

Introduction: Basal cell carcinomas are mostly treated surgically, mostly by surgery with postoperative histopathologic margin evaluation (“conventional surgery”), but large long-term data regarding recurrence by completeness of excisions is limited.

Methods: Retrospective cohort study of basal cell carcinomas treated by conventional surgery at different medical specialties in a large tertiary centre, between 2008 and 2014. Survival analysis with a Cox proportional-hazards was performed, stratified by completeness of excision (complete excision/incomplete excision) and adjusted to several potentially confounding covariates.

Results: A total of 2876 basal cell carcinomas were identified, of which 2306 (2100 primary, 206 recurrent) were considered eligible for analysis. During the 5-years of follow-up, there were 80 (4%) recurrences among 1980 complete excisions (16/1000 cases-year) and 83 (23.9%) recurrences among 348 incomplete excisions (100/1000 cases-year). Survival analysis was performed with multivariable adjustment. In the final adjusted model, we identified an association between relapse and re-intervention on recurrent tumors [adjusted Hazard Ratio (HR) 2.20 (95% Confidence interval (IC), 1.26-3.84), p=0.006], a wrong preoperative clinical diagnosis/surgery devoid of preoperative biopsy [adjusted HR 2.75 (95% CI, 1.68-4.5), p<0.001], treatment prior to 2012 [adjusted HR 1.47 (95% IC, 1.06-2.05), p<0.021] and surgery on a high-risk location, accordingly to the NCCN stratification [adjusted HR 2.18 (95% CI, 1.08-4.40), p<0.030]. By specific anatomic location, the likelihood of recurrence was especially high in the nose [adjusted HR 3.18 (95% CI 1.71-5.87), p<0.001] and eyelids [adjusted HR 3.08 (95% CI, 1.32-7.17), p=0.009]. There was also a trend towards higher recurrence in aggressive histological subtypes [adjusted HR 1.43 (95% CI 0.99-2.07), p<0.058].

Conclusion: Recurrent basal cell carcinomas, regardless of location, and primary basal cell carcinomas on high-risk locations of the face, especially on the eyelids and nose, should be considered to have a higher and independent likelihood of recurrence, even on “complete excisions” evaluated by histopathology. On the other hand, wait-andsee approaches in incompletely excised BCCs should be considered against a significant 5-year risk of relapse (1 in 10 lesions).

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Published
2020-07-14
How to Cite
Duarte, B., Vieira, L., Ribeiro, L., Pessoa e Costa, T., João, A., Varanda, A., & Cabete, J. (2020). Five-Year Risk of Basal Cell Carcinoma Recurrence After a Conventional Surgical Excision. Journal of the Portuguese Society of Dermatology and Venereology, 78(2), 115-122. https://doi.org/10.29021/spdv.78.2.1174
Section
Original Articles