Margin Involvement After Excision with Preoperative Dermoscopic Assessment of Head and Neck Basal Cell Carcinomas - a...

Basal cell carcinoma (BCC) is the most common cancer in Caucasians, and its incidence is rising. Incompletely treated tumors may cause destruction of adjacent structures and significant morbidity. This study aimed to evaluate margin involvement after surgical BCC excision with preoperative dermoscopic assessment and identify tumor features associated with positive and inadequate margins.

We retrospectively analyzed electronic medical records of 230 head and neck BCCs, surgically excised after preoperative dermoscopic border assessment.

Overall, 14 cases (6.2%) had positive margins, and 35 (16.1%) had inadequate (positive or close) margins. Lateral margins were positive and inadequate in 8 (3.5%) and 16 (7%) cases, respectively, while deep margins in 11 (4.8%) and 27 (12.6%) cases, respectively. The observed rate of lateral margin positivity is notably low compared to prior reports. Recurrence occurred in 2.8% of cases. Factors associated with inadequate margins included H-zone location (OR=3 [95% CI 1.1-8.1]), particularly on the nose (OR=2.3 [95% CI 1.1-4.8]), aggressive histological subtypes (OR=4.3 [95% CI 1.7-11.1]), ulceration (OR=2.3 [95% CI 1.1-4.8]), inflammatory infiltration (OR=3.9 [95% CI 1.7-8.7]), and elastosis (OR=2.9 [95% CI 1.2-6.8]). Lateral inadequate margin was more frequent in recurrent tumors (OR 5.3 [95% CI 1.6-16.9]).

This study supports the role of preoperative dermoscopic lesion borders assessment and multidisciplinary approach in BCC treatments, especially for high-risk tumors when micrographic surgery is not feasible. While further randomized controlled trials are warranted, incorporating preoperative dermoscopic assessment of BCC borders into clinical practice could improve patient outcomes and reduce healthcare costs.