Research Article| Volume 60, ISSUE 1, P41-47, January 2007

Basal cell carcinoma histological clearance margins: an analysis of 1539 conventionally excised tumours. Wider still and deeper?

  • R.W. Griffiths
    Corresponding author. 26 Cavendish Avenue, Dore, Sheffield S17 3NJ, UK. Tel.: +44 114 2434343; fax: +44 114 2619651.
    Department of Reconstructive Plastic Surgery, Northern General Hospital, Sheffield Teaching Hospitals Trust, Herries Road, Sheffield S5 7AU, UK
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  • S.K. Suvarna
    Department of Histopathology, Northern General Hospital, Sheffield Teaching Hospitals Trust, Herries Road, Sheffield S5 7AU, UK
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  • J. Stone
    Department of Histopathology, Northern General Hospital, Sheffield Teaching Hospitals Trust, Herries Road, Sheffield S5 7AU, UK
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Published:September 01, 2006DOI:


      An analysis of peripheral and deep margins of histological clearance around 1539 consecutive basal cell carcinomas excised by conventional surgery showed that 81 lesions (5.3%) were incompletely excised peripherally; 36 lesions (2.3%) were incompletely excised deeply; 13 lesions (0.8%) were incompletely excised peripherally and deeply. Nine hundred and ninety-six lesions (65%) were excised with a peripheral histological clearance margin<5 mm (0.1–4.9 mm), whereas 1303 lesions (85%) were excised with a deep histological clearance margin<5 mm (0.1–4.9 mm). Four hundred and eight lesions (27%) had a peripheral histological clearance margin of 5.0–9.9 mm, whereas 170 lesions (11%) had a deep histological margin of 5.0–9.9 mm.
      Peripheral histological clearance margins exceeded 10 mm in 41 lesions (3%) and deep histological margins exceeded 10 mm in 17 lesions (1%).
      Thus 30% of peripheral histological margins were 5 mm or more but only 12% of deep histological margins were 5 mm or more. Despite a relative sparing of deep tissue, incomplete excision in depth affected only 36 lesions compared with 81 incomplete peripheral excisions.
      Peripheral histological clearance was <5 mm (0.1–4.9 mm) for 55% of temple lesions, 50% of scalp lesions and 43% for limb lesions. In the cosmetically sensitive areas of peri-orbital region, nose, cheek, lip, neck and chin more than 70% of lesions were excised with a peripheral histological margin<5 mm.
      This study of conventional surgical excision of basal cell carcinomas with an incomplete excision rate of 8% has shown that 65% of lesions were excised with <5 mm histological clearance peripherally and 85% with <5 mm deep clearance. These figures for ‘normal tissue sacrifice’ are not excessive when compared with those of ‘tissue sparing’ Mohs' micrographic surgery in which the operator may take a margin of several millimetres of normal tissue in the initial ‘slice’, or in the subsequent ‘safety margin’ beyond the eventual tumour free plane.
      However, peripheral margins did exceed 5 mm in more than 30% of lesions of scalp, temple and forehead, and for these sites where even with loupe magnification the tumour edge could be difficult to define, either frozen section control or Mohs' technique, might with benefit be more often used in order to minimise normal tissue sacrifice.


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