Incompletely excised basal cell carcinoma: a management dilemma?

Reported recurrence rates for incompletely excised basal cell cancers (BCC) vary widely (30-67%), and the destructive potential of recurrent BCC is well known. When surgically treated BCC are reported by the pathologist as incompletely excised the surgeon is placed in the dilemma of whether to perform an immediate wider excision, or to reserve further treatment until there is clinical evidence of recurrence. The aim of the present study is to determine if there are any clinical or morphological features which may help in this management dilemma.

Middlemore Hospital histology records were reviewed. In 1986, 82 out of a total of 723 BCC excised were reported to be incompletely excised. The management and recurrence rates of the incompletely excised BCC were determined from the patient records and telephone follow up where necessary. The clinical and morphological features were correlated with the recurrence rates, with the aim of developing a management strategy.

The overall recurrence rate was 30.0%. Median time to recurrence was 18.5 months (range 1.5-55 months). Neither the margin of incomplete resection (deep, lateral or both margins), the site of tumour, the histological variant, the sex of the patient, nor prior treatment had any discernible effect on recurrence rates.

Observation is an acceptable management option in most situations, as only one-third of incompletely excised lesions needed further treatment. Most recurrences occurred early and careful follow up of these patients was indicated for at least 3 years.