Incomplete excision of basal cell carcinoma: a prospective multicentre audit

Area of Science:

• Plastic Surgery
• Oncology
• Clinical Governance

Background:

• Incomplete excision of basal cell carcinoma (BCC) impacts patient outcomes and requires clinical governance.
• Previous UK studies on BCC excision were retrospective and regionally limited.
• Lack of national standards for BCC excision audits hinders consistent clinical practice.

Purpose of the Study:

• To prospectively audit incomplete excision rates of basal cell carcinoma across different hospital types.
• To identify factors influencing incomplete BCC excision.
• To establish a benchmark for clinical governance in plastic surgery units.

Main Methods:

• A 1-year prospective audit of 757 basal cell carcinoma excisions from 600 patients.
• Data collected simultaneously from a regional plastic surgery unit, a supraregional cancer hospital, and a district general hospital.
• Logistic regression analysis used to adjust for confounding factors.

Main Results:

• Overall incomplete excision rate was 4.5% (34/757 lesions).
• Incomplete excision rates were 3.2% (regional), 3.1% (district), and 7.5% (supraregional cancer hospital).
• Surgeon grade, minimal excision margin, and histological subtype were significant predictors of incomplete excision.

Conclusions:

• Incomplete basal cell carcinoma excision rates differ across hospital settings.
• Surgeon experience, excision margin adequacy, and tumor histology are key factors influencing complete BCC excision.
• Findings provide data for developing national standards and improving clinical governance in plastic surgery.