Surgical management and outcomes in localized vulvar basal cell carcinoma: a National Cancer Database Study

We evaluated factors associated with positive surgical margins and overall survival in localized vulvar basal cell carcinoma using the National Cancer Database (2004-2023). Patients with localized vulvar basal cell carcinoma undergoing surgical resection were included. Multi-variable logistic regression identified factors associated with positive margins. Overall survival was assessed using Kaplan-Meier estimates and multi-variable Cox regression. Among 2998 patients, 249 (8.3%) had positive margins. Older age (adjusted odds ratio [aOR] 1.022 per year, 95% confidence interval [CI] 1.008 to 1.035), tumor size >20 mm (aOR 2.451, 95% CI 1.169 to 5.139), basosquamous histology (aOR 1.873, 95% CI 1.071 to 3.275), and organ-sparing surgery (aOR 2.224, 95% CI 1.686 to 2.933) were independently associated with positive margins. Five-year overall survival was 81.79% after organ-sparing surgery, 82.75% after partial vulvectomy, and 73.30% after radical vulvectomy (log-rankp= .0013). In adjusted analyses, organ-sparing surgery was not associated with worse overall survival compared with partial vulvectomy, whereas radical vulvectomy was associated with worse survival (aHR 1.348; 95% CI 1.034 to 1.757). Organ-sparing surgery is associated with higher odds of positive margins but is not associated with worse overall survival in adjusted analyses compared with partial vulvectomy. These findings may help inform surgical decision-making in vulvar basal cell carcinoma.