Natural Course of the Incompletely-Excised Basal Cell Carcinomas

Jang, Yong Hyun; Lee, Seok Jong; Lee, Jae Chul; Lee, Jin Sub; Song, Chang Hyun; Lee, Weon Ju; Kim, Do Won

Abstract

BACKGROUND
Mohs micrographic surgery (MMS) is regarded as the standard therapeutic modality for high-risk basal cell carcinoma (BCC). However, wide local excision (WLE) is performed more frequently than MMS in Korea because of practical restrictions. For this reason, involvement of surgical margin after WLE may be detected postoperatively.
OBJECTIVE
Our purpose was to compare the recurrence rate between histopathologically confirmed an "incomplete excision" group and a "complete excision" group to evaluate whether close follow-up could be an acceptable management option in incompletely-excised BCC patients when immediate re-excision or other adjunctive therapy was difficult to enforce.
METHODS
From 1999 to 2008, a total of 227 primary BCC cases with more than 2 year follow-up after surgical resection were reviewed. We divided the cases into the completely-excised and incompletely-excised group and the recurrence rates of both groups were compared.
RESULTS
The recurrence rate out of the total 227 cases was 1.3% (3/227). Eleven cases (4.8%, 11/227) were reported to be incompletely excised. Of the 11 surgical incompletely-excised BCC, only 1 (9.0%, 1/11) case recurred. Two (0.9%, 2/216) cases recurred in the 216 completely-excised patients. Difference of recurrence rate between the completely-excised group and incompletely-excised group was not statistically significant.
CONCLUSION
When the initial excision of a primary BCC reveals incomplete excision and, more importantly, immediate further treatment is not eligible due to various causes such as old age or combined medical and surgical problems, close follow-up with detailed informed consent instead of prompt re-excision could be a reasonable alternative in carefully-selected patients.