Evaluation of surgical margins in Basal cell carcinoma by surgical specialty

Complete surgical excision is the most common treatment for basal cell carcinoma (BCC), and this intervention is often performed by surgeons who are not dermatologists (e.g., plastic surgeons, general surgeons, oral and maxillofacial surgeons, ophthalmologists, and otorhinolaryngologists).

To determine positive margin rates in BCCs removed by surgeons from different specialties and to identify clinical and pathologic factors that might explain potential differences between specialties.

We retrospectively reviewed the pathology reports of all BCCs diagnosed at Hospital Universitari Vall d'Hebron between January 2009 and March 2001. The statistical methods included a descriptive analysis of clinical and pathologic variables, standard statistical analyses, and multivariate logistic regression.

We included 921 BCCs from 750 patients; 549 of the tumors had been excised by a dermatologist. The overall positive margin rate was 12.6%, but the rate for tumors removed by dermatologists was significantly lower than that for those removed by other specialists (6.7% vs 21.5%). There was a 3.8-fold increased relative risk of positive margins following excision by a surgeon who was not a dermatologist, independently of patient age, tumor site, maximum diameter of the resected specimen, and histologic subtype.

Accurate macroscopic identification of tumor margins, which are often difficult to see, and familiarity with the natural history of BCC are key factors in the successful surgical treatment of BCCs. The higher rate of tumor-free margins achieved by dermatologists in this study is probably mainly due to their greater experience in these 2 areas.