Audit of histologically incompletely excised basal cell carcinomas: Recommendations for management by re-excision

Abstract

In an audit of 1392 basal cell carcinomas arising in 1165 patients, excised under the care of one consultant in the 10 years from 1988 to 1997, 99 (7%) were reported histologically as incompletely excised. Lateral margins alone were involved in 54 (55%), deep margins in 36 (36%) and both in 9 (9%). Although the policy throughout this period was to re-excise all such lesions, 74/99 (75%) were re-excised (compared with an average re-excision rate of 30% through other published series). For those patients undergoing re-excision, residual tumour was reported histologically in 40/74 (54%). Peri-orbital lesions showed an overall incomplete excision rate of 13% (range 11-17%); however, only 4/16 of re-excisions in this area revealed residual tumour. Many clinicians have traditionally observed patients with incompletely excised basal cell carcinomas. The present study reports the largest series of re-excisions after incomplete excision of basal cell carcinoma, and has revealed that on the balance of probability such re-excisions will reveal residual tumour. Re-excision appears the appropriate course in almost all the anatomical areas studied although, with the exception of the inner canthus, periorbital lesions will have a low probability of residual tumour being identified.