Wilson A W, Howsam G, Santhanam V, Macpherson D, Grant J, Pratt C A, Townend J V
Maxillofacial Unit, St. Richards Hospital, Royal West Sussex Trust, Spitalfield Road, Chichester, West Sussex PO19 4SE, UK.
Br J Oral Maxillofac Surg. 2004 Aug;42(4):311-4. doi: 10.1016/j.bjoms.2004.02.030.
We made a retrospective audit of all basal cell carcinomas excised in the Maxillofacial Units at St. Richard's Hospital, Chichester and the Worthing and Southlands NHS Trust between 1990 and 1999. A total of 3795 BCCs were excised. Of these, 3560 were completely excised (93.8%) and 235 were incompletely excised (6.2%), which compares favourably with other series. Of these, 84 patients had further excision, 11 had radiotherapy, and 140 were kept under review. Residual tumour was present in 45% of the re-excised specimens. Of the 140 cases managed by observation, 21% recurred. Notably, 31% of patients in the observation cohort died of other causes without recurrence. Incomplete excision was significantly more likely (P < 0.001) if multiple lesions were excised at the time of operation. Involvement of multiple margins was not a significant risk factor for recurrence in the 'observed' cohort. This study shows that a flexible strategy, which balances observation, further excision and radiotherapy, is superior to any single approach.
我们对1990年至1999年间在奇切斯特圣理查德医院颌面科以及沃辛和南海岸国民保健服务信托基金切除的所有基底细胞癌进行了回顾性审计。共切除3795例基底细胞癌。其中，3560例完全切除（93.8%），235例不完全切除（6.2%），这一比例优于其他系列研究。其中，84例患者接受了进一步切除，11例接受了放疗，140例接受随访观察。再次切除的标本中有45%存在残留肿瘤。在接受观察的140例病例中，21%复发。值得注意的是，观察队列中有31%的患者未复发但死于其他原因。如果手术时切除多个病灶，不完全切除的可能性显著更高（P < 0.001）。在“观察”队列中，多个切缘受累并非复发的显著危险因素。本研究表明，一种平衡观察、进一步切除和放疗的灵活策略优于任何单一方法。
