Comparison of completely versus incompletely excised cutaneous squamous cell carcinomas

This is a retrospective case series of cutaneous squamous cell carcinomas (SCCs) which were incompletely excised in National Skin Centre, Singapore from 1991 to 1995. This study compared the characteristics of completely excised versus incompletely excised cutaneous SCCs.

All patients with histologically confirmed SCCs were traced from computerised medical database and information regarding patient profile, tumour characteristics, surgical treatment and outcome were collated. All patients were recalled for clinical examination and documentation of cure. Completely excised and incompletely excised SCCs were compared with regards to the patient and tumour characteristics.

There were 57 patients with 63 SCCs who were treated with surgical excision over the 5-year period. Fifty were recalled for physical examination. There were 30 males and 27 females and their mean age was 83.3 years. All except 1 were Chinese of Fitzpatrick skin type 4. One-third of patients had daily or weekly sun exposure in the past and 21.1% had occupational sun exposure; 3.5% had prior arsenic exposure and 3.5% were previously treated with radiotherapy for other malignancies. The mean duration of SCCs was 18.7 months; 7.9% of patients had multiple SCCs and 15.9% had underlying actinic keratoses. The mean diameter of the tumours was 1.97 cm and nearly half were located on the head and neck. All the SCCs were primary and localised to the skin; 84.1% of them were completely excised with a 4 to 6 mm margin. Incompletely excised SCCs were associated with the male sex, larger tumours and tumours on the genitals and lower limbs.

In our experience, the tumour clearance rate is 84.1% following conventional excision. Incomplete excision is associated with male sex, larger tumours and those on the genitals and lower limbs.