Five-Year Risk of Basal Cell Carcinoma Recurrence After a Conventional Surgical Excision
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).
Lomas A, Leonardi-Bee J, Bath-Hextall F. British Journal of Dermatology A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166:1069–80.
Kauvar ANB, Cronin T, Roenigk R, Hruza G, Bennett R. Consensus for Nonmelanoma Skin Cancer Treatment : Basal Cell Carcinoma , Including a Cost Analysis of Treatment Methods. 2015;550–71.
Cameron MC, Lee E, Hibler B, Barker CA, Mori S, Cordova M, et al. Basal Cell Carcinoma: Part 1. J Am Acad Dermatol [Internet]. 2018; Available from: https://doi.org/10.1016/j.jaad.2018.03.060
Otley CC, Salasch SJ. Mohs surgery: efficient and effective. Br J Ophthalmol. 2004;1:1223–9.
Codazzi D, Velden J Van Der, Carminati M, Bruschi S, Bocchiotti MA, Serio C Di, et al. Positive compared with negative margins in a single-centre retrospective study on 3957 consecutive excisions of basal cell carcinomas . Associated risk factors and preferred surgical management. J plast Surg Hand Surg. 2014;48(1):38–43.
Patel SS, Cliff SH, Booth PW. Incomplete removal of basal cell carcinoma : what is the value of further surgery ? Oral Maxillofac Surg. 2013;17:115–8.
Andersen JS, Berg D, Bowen GM, Cheney RT, Daniels GA, Glass LF, et al. Basal Cell Skin Cancer , Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2016;14(5):574–97.
Loo E Van, Mosterd K, Krekels GAM, Roozeboom MH, Ostertag JU, Dirksen CD, et al. Surgical excision versus Mohs ’ micrographic surgery for basal cell carcinoma of the face : A randomised clinical trial with 10 year follow-up q. Eur J Cancer [Internet]. 2014;50(17):3011–20. Available from: http://dx.doi.org/10.1016/j.ejca.2014.08.018
Linos E, Parvataneni R, Stuart SE, Boscardin WJ, Landefeld CS, Chren M-M. Treatment of Nonfatal Conditions at the End of Life. JAMA Inter Med. 2017;173(11):1006–12.
Lee Dellon A, De Silva S, Connoly M, Ross A. Prediction of Recurrence in Incompletely Excised Basal Cell Carcinoma. 1984. p. 860–71.
Griffiths RW. Audit of histologically incompletely excised basal cell carcinomas : recommendations for management by re-excision. Br J Plast Surg. 1999;52(1997):24–8.
Wilson AW, Howsam G, Santhanam V, Macpherson D, Grant J, Pratt CA, et al. Surgical management of incompletely excised basal cell carcinomas of the head and neck. 2004;42:311–4.
Bichakjian C, Armstrong A, Eisen DB, Iyengar V, Lober C, Margolis DJ, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540–59.
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