Kiely J, Kostusiak M, Bloom O, Roshan A
Department of Plastic Surgery, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK.
Department of Plastic Surgery, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK.
J Plast Reconstr Aesthet Surg. 2020 Jan;73(1):43-52. doi: 10.1016/j.bjps.2019.06.034. Epub 2019 Jul 29.
In the UK, the British Association of Dermatology-British Association of Plastic, Reconstructive and Aesthetic Surgery (BAD-BAPRAS) guidelines recommend excision of high-risk cutaneous squamous cell carcinomas (cSCCs), including poorly differentiated cSCCs, with a minimum peripheral margin of 6 mm.
We assess whether the BAD-BAPRAS minimum margin achieves histological clearance in poorly differentiated cSCCs.
Demographics, surgical notes and histological reports from all patients having a primary cSCC excised at the Plastic Surgery Department of Addenbrooke's Hospital, Cambridge, UK, between January 2017 and April 2018 were analysed. Ordinal regression was performed for excision margin status versus histological grade by using size and site as co-variates.
Of 296 cSCCs, 38(12.8%) were poorly differentiated. Patients with poorly differentiated cSCCs were older (81.1 years vs. 76.7 years, p = 0.038), had lesions on the face or scalp (89.2% vs. 52.1%, p = 0.0001), and had lymphovascular (10.5% vs. 0%, p = 0.001) or perineural invasion (15.8% vs. 2%, p = 0.002). Well-differentiated cSCCs were excised with an average peripheral margin of 4.72 mm (95% CI 4.25-5.18 mm), while poorly differentiated cSCCs were excised with a margin of 6.42 mm(95% CI 5.58-7.28 mm). Close or involved peripheral margins were seen in 3% of well-differentiated lesions but in 13.2% of poorly differentiated lesions (OR=45.02; p = 0.003). Deep margins were close in 13.1% (none involved) of well-differentiated lesions but close or involved in 50% of poorly differentiated lesions (OR=11.94; p = 0.001).
We demonstrate that poorly differentiated cSCCs are frequently incompletely excised in both peripheral and deep planes, despite adherence to guidelines. The UK BAD-BAPRAS guidelines should be urgently updated in line with international consensus.
在英国，英国皮肤科协会 - 英国整形、重建与美容外科协会（BAD - BAPRAS）指南建议切除高危皮肤鳞状细胞癌（cSCC），包括低分化cSCC，切缘外周至少为6毫米。
我们评估BAD - BAPRAS规定的最小切缘是否能使低分化cSCC达到组织学清除。
分析了2017年1月至2018年4月在英国剑桥阿登布鲁克医院整形外科切除原发性cSCC的所有患者的人口统计学资料、手术记录和组织学报告。以肿瘤大小和部位作为协变量，对切缘状态与组织学分级进行有序回归分析。
296例cSCC中，38例（12.8%）为低分化。低分化cSCC患者年龄较大（81.1岁对76.7岁，p = 0.038），面部或头皮有病变（89.2%对52.1%，p = 0.0001），且有淋巴管（10.5%对0%，p = 0.001）或神经周围浸润（15.8%对2%，p = 0.002）。高分化cSCC切除时外周平均切缘为4.72毫米（95%可信区间4.25 - 5.18毫米），而低分化cSCC切除时切缘为6.42毫米（95%可信区间5.58 - 7.28毫米）。3%的高分化病变切缘接近或受累，而低分化病变中这一比例为13.2%（比值比 = 45.02；p = 0.003）。13.1%的高分化病变深部切缘接近（无受累），而低分化病变中50%的深部切缘接近或受累（比值比 = 11.94；p = 0.001）。
我们证明，尽管遵循指南，但低分化cSCC在外周和深部平面常切除不完全。英国BAD - BAPRAS指南应根据国际共识紧急更新。
