Summary
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.
Keywords
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Article info
Publication history
Published online: September 01, 2006
Accepted:
June 16,
2006
Received:
April 11,
2006
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
