Do basal cell carcinomas recur after complete conventional surgical excision?

Area of Science:

• Dermatology
• Surgical Oncology
• Pathology

Background:

• Basal cell carcinoma (BCC) is the most common type of skin cancer.
• Conventional surgical excision is a standard treatment for BCC.
• Assessing recurrence rates and factors influencing them is crucial for patient management.

Purpose of the Study:

• To evaluate the long-term recurrence rate of basal cell carcinoma (BCC) after conventional surgical excision.
• To analyze the relationship between clearance margins and recurrence.
• To differentiate between true recurrences and new primary lesions.

Main Methods:

• Retrospective analysis of 1378 patients treated for 1635 BCCs between 1988-1998.
• Inclusion of only histologically completely excised lesions with a minimum 5-year follow-up.
• Measurement of clearance margins and photographic recording of lesions.

Main Results:

• A combined recurrence rate of 1.3% (20/1516 lesions) was observed over a minimum 5-year follow-up.
• Probable recurrences (contiguous to scar) had a median interval of 41 months with a 2 mm clearance margin.
• Possible recurrences (near scar) had a median interval of 59 months with a 4.1 mm clearance margin.
• Recurrences were more common on the temple and forehead, suggesting field changes rather than residual disease.

Conclusions:

• Conventional surgical excision of BCC demonstrates a low probability of recurrence.
• The study suggests that many 'recurrent' lesions may be new primary tumors, especially in sun-exposed areas.
• Adequate clearance margins are important, but the low overall recurrence rate supports the efficacy of conventional excision and histological assessment.