Few patients with positive margins after basal cell excision have recurrence

Among patients with incompletely excised basal cell carcinoma (BCC), only about 16% with positive histopathologic margins have clinical recurrence, according to a study published online June 13 in Dermatology.

Maria Daviti, M.D., from Aristotle University in Thessaloniki, Greece, and colleagues reported the real-life management of incompletely excised BCC in a tertiary referral center and compared recurrence rates according to management modality in a retrospective study.

All BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep) over a five-year period were identified. Patients were categorized into three groups: immediate re-excision (group 1; 26 patients); follow-up without any additional treatment (group 2; 40 patients); and treatment with adjuvant/complementary nonsurgical treatment (group 3; 18 patients).

The researchers found that based on histopathological reports, 53.8% of 26 tumors in group 1 that were re-excised had residual tumor. After a mean follow-up of 17 months, a clinical recurrence occurred in 14 of 84 patients (16.7%), with a median of 14 months to recurrence. Recurrence developed in 25% of the patients without any additional treatment, compared with 11.1% of those receiving nonsurgical treatments.

"Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients," the authors write. "This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy."

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