Outcome of basal cell carcinoma excision with 2 mm surgical margin in Japanese patients: A retrospective study of one-step surgery
Kaori Kyono,
Yoshinori Tamada,
Michito Ara,
Shin-Ichiro Yamagishi,
Ayako Higuchi,
Keiichiro Iida,
Naoko Wada,
Makoto Mikami,
Satoshi Urushidate
Affiliations
Kaori Kyono
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan; Department of Plastic Surgery, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane, Hachinohe City, Aomori, 031-8551, Japan
Yoshinori Tamada
Department of Medical Data Intelligence, Research Center for Health-Medical Data Science, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
Michito Ara
Department of Plastic Surgery, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane, Hachinohe City, Aomori, 031-8551, Japan
Shin-Ichiro Yamagishi
Department of Diagnostic Pathology, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane, Hachinohe City, Aomori, 031-8551, Japan
Ayako Higuchi
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
Keiichiro Iida
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
Naoko Wada
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
Makoto Mikami
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
Satoshi Urushidate
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan; Correspondence to: Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori 036-8562, Japan. Tel:+81(0)172 39 5119. Fax:+81(0)172 35 9220.
Summary: Background: Basal cell carcinoma is the most common skin malignancy. The standard treatment is surgical excision with predetermined margins. Some argue that the currently recommended surgical margins are excessive, and it is questionable whether such wide surgical margins should be applied to all lesions. We statistically investigated excisions with narrow margins and tried to identify the risk factors for recurrence after one-step surgery. Methods: Basal cell carcinomas were excised at a single institute in Japan over a six-year period and the recurrence rates were retrospectively analyzed using pathological reports and case notes. We reviewed the microscopic findings of the excised specimens and examined the excisional margin status, tumor subtype, and perineural invasion. Results: Forty-eight basal cell carcinomas (45 primary and 3 recurrent) that were identified in Japanese patients were included in this study. Among the primary lesions, well-pigmented and well-defined lesions did not show any involvement of the surgical margins, perineural invasion, or development of local recurrence. Recurrent lesions were significantly associated with positive surgical margins (side margin, P<0.01; deep margin, P<0.01) during the primary operation; however, no association was found with local recurrence after re-resection. Significant differences were observed in perineural invasion and the tumor subtype, especially in the aggressive subtype (P<0.05). Conclusions: A 2 mm margin allows for the safe excision of primary lesions with well-pigmented and well-defined basal cell carcinoma in Japan. Recurrent lesions can be treated with narrow margins by reconstruction after confirmation of a negative margin, instead of performing a common resection with wide margins.
