Cutaneous squamous cell carcinoma with incomplete margins demonstrate higher tumour grade on re-excision

We retrospectively evaluated all our cases of re-excised cutaneous squamous cell carcinomas (CSCCs) in the last 10 years to examine whether they change grade in re-excision histology reports.

The medical files of 525 patients, which had surgical excision of CSCCs in the Plastic Surgery Department of Aristotle University of Thessaloniki between January 2007 and December 2017 were retrospectively evaluated. All primary and recurrent tumours that were incompletely excised were included in the study. The tumour's grade of both the initial and re-excision histological reports (Broders classification: well, moderate, or poor), age, sex, tumour location, size, infiltration borders (deep or lateral), and perineural invasion was documented.

From a total number of 525 CSCCs, 24 patients with 24 incompletely excised lesions were identified. Perineural invasion was noticed in 16 (66%) of patients. In 15 cases (62, 5%), poorer differentiation was recorded following re-excision (group A), whilst in nine patients (37, 5%), the grade remained the same (group B). No statistical significance was observed on age (P = 0.106), tumour size (P = 0.382) and perineural invasion (P = 0.658) in both groups. A positive correlation between male gender and infiltrated border location (deep) and change of grade was observed (P = 0.014, P = 0.000).

We would strongly advise re-excision in incompletely excised lesions except in patients that are unwilling or unfit to undergo another surgical procedure as incompletely excised lesions may change into a poorer degree of differentiation in re-excision histology reports.