Chiller K, Passaro D, McCalmont T, Vin-Christian K
Department of Dermatology, University of Califorinia, San Francisco, 1701 Divisadero St, Third Floor, San Francisco, CA 94143, USA.
Arch Dermatol. 2000 Nov;136(11):1327-32. doi: 10.1001/archderm.136.11.1327.
To determine whether curettage before excision of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) improves margin clearance rates.
A retrospective, nonrandomized, case-control series of nonmelanoma skin cancers treated with preexcisional curettage followed by simple excision was identified using a computerized search of the database of a dermatopathology service. A validation cohort was established by manually identifying nonmelanoma skin cancers treated with wide excision on a given day.
All analyzed specimens were derived from the Dermatopathology Service at the University of California, San Francisco, a university-based laboratory that provides interpretation of skin biopsy specimens received directly from community (90%) and academic (10%) practices.
Our retrospective cohort consisted of all nonrecurrent nonmelanoma skin cancers diagnosed by biopsy and treated by simple excision between April 1, 1997, and April 30, 1999. There were 1983 BCCs and 849 SCCs included in our study. The validation cohort included skin cancers diagnosed by biopsy treated with simple excision on the 16th day of each month during the same period.
Preexcisional curettage.
We compared the frequency of tumor margin involvement of curetted vs noncuretted lesions. Margin involvement was considered surgical failure.
Forty-two pecent of BCCs and 34% of SCCs were curetted before excision. In BCC, risks for surgical failure included head and neck lesions (P<.001), lesions treated by physicians performing fewer than 51 procedures (P<.001), and invasive subtypes (P<.01). Factors associated with surgical failure in SCC included in situ disease (P=.01) and an older (77 vs 74 years) patient population (P=.05). In univariate analysis, curettage before excision decreased the surgical failure rate for BCC by 24% (P=.03) but did not decrease the rate for SCC (P=.8). In multivariate analysis, curettage of BCC reduced surgical failure rates by 26% when the physician performed 50 skin cancer excisions or less during the study (odds ratio, 0.74; 95% confidence interval, 0.57-0.95;P=.02).
Preoperative curettage decreases the frequency of positive margins in the management of BCC but not of SCC.
确定在切除基底细胞癌（BCC）和鳞状细胞癌（SCC）之前进行刮除术是否能提高切缘清除率。
通过对皮肤病理学服务数据库进行计算机检索，确定了一系列采用切除前刮除术随后进行单纯切除术治疗的非黑色素瘤皮肤癌的回顾性、非随机病例对照研究。通过人工识别在给定日期接受广泛切除术治疗的非黑色素瘤皮肤癌建立了一个验证队列。
所有分析的标本均来自加利福尼亚大学旧金山分校的皮肤病理学服务部，这是一个基于大学的实验室，负责对直接从社区（90%）和学术机构（10%）的医疗实践中接收的皮肤活检标本进行解读。
我们的回顾性队列包括1997年4月1日至1999年4月30日期间经活检诊断并接受单纯切除术治疗的所有非复发性非黑色素瘤皮肤癌。我们的研究纳入了1983例基底细胞癌和849例鳞状细胞癌。验证队列包括同期每月第16天经活检诊断并接受单纯切除术治疗的皮肤癌。
切除前刮除术。
我们比较了刮除与未刮除病变的肿瘤切缘受累频率。切缘受累被视为手术失败。
42%的基底细胞癌和34%的鳞状细胞癌在切除前进行了刮除。在基底细胞癌中，手术失败的风险包括头颈部病变（P<0.001）、由手术操作少于51例的医生治疗的病变（P<0.001）以及浸润性亚型（P<0.01）。与鳞状细胞癌手术失败相关的因素包括原位疾病（P=0.01）和年龄较大（77岁对74岁）的患者群体（P=0.05）。在单变量分析中，切除前刮除术使基底细胞癌的手术失败率降低了24%（P=0.03），但未降低鳞状细胞癌的手术失败率（P=0.8）。在多变量分析中，当医生在研究期间进行50例或更少的皮肤癌切除术时，基底细胞癌的刮除术使手术失败率降低了26%（比值比，0.74；95%置信区间，0.57 - 0.95；P=0.02）。
术前刮除术可降低基底细胞癌治疗中切缘阳性的频率，但对鳞状细胞癌无效。
