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Recurrence Rates of Incompletely Excised Primary Basal Cell Carcinoma Treated With Mohs Micrographic Surgery and
Georgia De'Ambrosis1,2, Brian De'Ambrosis1,2, Perry Wilson3
1South East Dermatology, Brisbane, Queensland, Australia.
Background/Objectives:
Incompletely excised primary basal cell carcinoma (pBCC) is a frequently encountered scenario in clinical practice, yet the significance of the phenomenon is not well described in current literature. Re-excision is recommended for high-risk incompletely excised pBCCs, but recurrence rates post re-excision of pBCCs with Mohs micrographic surgery (MMS) are not currently well documented.
Method:
A retrospective cohort study was undertaken, identifying patients who had undergone re-excision with MMS for pBCC prior to June 2015 from the private practices of two MMS proceduralist dermatologists' practices in Queensland, Australia. Cases required a minimum follow up of 5 years post-definitive treatment.
Results:
141 patients were identified, with 104 ultimately being included. 31 patients did not respond, and 6 formally withdrew. 104 incompletely excised pBCCs re-excised with MMS, with some cases receiving adjuvant post-operative radiotherapy (PORT), experienced no recurrence over an average follow up period of 9.2 years. 93 (92.1%) of the 104 cases consisted of an aggressive BCC subtype, and 54 (51.9%) of the cases were in a high-risk anatomical location. Perineural invasion was present in 12 (11.5%) cases, and 6 (5.7%) of the cases received PORT.
Conclusion:
MMS may be an effective treatment option for the management of incompletely excised pBCC in immunocompetent patients. For high-risk cases, PORT is an effective adjuvant therapy in combination with MMS. Future prospective studies with greater participant numbers and the inclusion of recurrent BCCs, as well as BCCs initially treated with non-surgical methods, may provide further insights into the role of MMS in these clinical contexts.
