Thomas Damon J, King Alan R, Peat Bruce G
Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Auckland, New Zealand.
Plast Reconstr Surg. 2003 Jul;112(1):57-63. doi: 10.1097/01.PRS.0000067479.77859.31.
Scientific evidence for advisable excision margins for nonmelanotic skin carcinoma is poorly documented. Recommended excision margins vary from 2 to 15 mm. A prospective study was performed on 150 skin lesions excised over a 9-month period in an outpatient facility at the authors' institution. Primary nonmelanotic skin lesions were clinically diagnosed as either basal cell carcinoma (nodular, superficial, infiltrating, or sclerosing) or squamous cell carcinoma (well, moderately, or poorly differentiated). Macroscopic surgical excision margins were individually assessed, measured, and excised. Histopathologic analysis was then independently performed to determine the correct diagnosis and to measure the actual microscopic lateral and deep excision margins.Sixty-one percent of lesions were basal cell carcinoma, 25 percent were squamous cell carcinoma, and 15 percent were benign or premalignant. Diagnostic accuracy was 81 percent for basal cell and 59 percent for squamous cell carcinoma. The average diameter of the basal cell carcinoma was 12.1 mm; 47 percent of these lesions had a diameter of less than 10 mm. The average diameter of the squamous cell carcinoma was 16.9 mm; 26 percent of these lesions had a diameter of less than 10 mm. The mean surgical margin was 4.2 mm (3.2 mm adjusted for shrinkage), whereas the mean microscopic lateral margin was 3.4 mm. Overall, complete excision was achieved for 98 percent of basal cell carcinoma and 100 percent of squamous cell carcinoma. The raw data were analyzed to assess the suitability of 1-, 2-, 3-, or 4-mm surgical excision margins. A 4-mm surgical margin would give a microscopic lateral margin beyond one microscopic high-power field (0.5 mm) in 96 percent of cases of basal cell carcinoma and in 97 percent of cases of squamous cell carcinoma. The authors recommend a 4-mm surgical margin as the optimal treatment for skin lesions clinically diagnosed as basal cell or squamous cell carcinoma that are suitable for excision in an outpatient facility. Well-demarcated lesions, such as a nodular basal cell carcinoma, may be excised with a 3-mm margin.
关于非黑素性皮肤癌的建议切除边缘的科学证据记录不足。推荐的切除边缘范围为2至15毫米。在作者所在机构的门诊设施中，对9个月内切除的150个皮肤病变进行了一项前瞻性研究。原发性非黑素性皮肤病变临床诊断为基底细胞癌（结节型、表浅型、浸润型或硬化型）或鳞状细胞癌（高分化、中分化或低分化）。对宏观手术切除边缘进行单独评估、测量并切除。然后独立进行组织病理学分析，以确定正确诊断并测量实际的微观外侧和深部切除边缘。61%的病变为基底细胞癌，25%为鳞状细胞癌，15%为良性或癌前病变。基底细胞癌的诊断准确率为81%，鳞状细胞癌为59%。基底细胞癌的平均直径为12.1毫米；其中47%的病变直径小于10毫米。鳞状细胞癌的平均直径为16.9毫米；其中26%的病变直径小于10毫米。平均手术边缘为4.2毫米（经收缩调整后为3.2毫米），而平均微观外侧边缘为3.4毫米。总体而言，98%的基底细胞癌和100%的鳞状细胞癌实现了完全切除。对原始数据进行分析，以评估1毫米、2毫米、3毫米或4毫米手术切除边缘的适用性。4毫米的手术边缘在96%的基底细胞癌病例和97%的鳞状细胞癌病例中，将使微观外侧边缘超出一个微观高倍视野（0.5毫米）。作者建议，对于临床诊断为基底细胞或鳞状细胞癌且适合在门诊设施切除的皮肤病变，4毫米的手术边缘是最佳治疗方法。边界清晰的病变，如结节型基底细胞癌，可采用3毫米的边缘切除。
