Perianal Basal Cell Carcinoma: 35-Year Experience

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• Basal cell carcinoma (BCC) of the perianal region is an uncommon anorectal malignancy, distinct from cutaneous BCC as it is not associated with ultraviolet radiation exposure.
• Limited literature exists on perianal BCC due to its rarity and diagnostic challenges, presenting unique surgical considerations compared to BCC in other anatomical sites.
• This study details the largest series to date on the surgical management of perianal basal cell carcinoma, offering insights into its clinical behavior and treatment outcomes.

Discussion:

• Perianal BCC frequently presents synchronously with BCC in other body areas, necessitating comprehensive patient evaluation.
• While local excision is a successful treatment modality for perianal BCC, a high incidence of wound dehiscence (60%) was observed post-operatively.
• Despite surgical challenges and wound complications, the study found no evidence of disease recurrence or mortality, underscoring the efficacy of surgical intervention.

Key Insights:

• A significant proportion of patients (27.6%) presented with multiple basal cell carcinomas in different locations.
• Ninety-three percent of patients achieved adequate disease treatment via local excision.
• No recurrences or disease-related mortality were recorded during the 5.5-year average follow-up period.

Outlook:

• Further research with larger, multi-center, randomized trials is warranted to establish definitive treatment guidelines for perianal basal cell carcinoma.
• Continued investigation into optimizing surgical techniques and wound care protocols may help mitigate the high rate of post-operative wound complications.
• Enhanced awareness and diagnostic protocols are crucial for early detection and effective management of this rare malignancy.