Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
Dermatol Surg. 2022 Jul 1;48(7):704-710. doi: 10.1097/DSS.0000000000003462.
Keratinocyte carcinomas (KCs) are the most diagnosed cancers worldwide and are commonly excised via complete margin assessment (CMA) or excision with sectional assessment (SA). National Comprehensive Cancer Network guidelines encourage CMA for KC with high-risk features.
To systematically compare recurrence outcomes for CMA vs SA in high-risk KC based on National Comprehensive Cancer Network guidelines criteria.
EMBASE and MEDLINE were searched for articles reporting recurrences of high-risk KC undergoing excision using CMA or SA. High-risk KCs were defined as recurrent, having perineural invasion (PNI), or basal cell carcinomas (BCC) with aggressive histology. Chi-squared tests and risk ratios evaluated differences between CMA and SA groups, and a random-effects meta-analysis was performed.
Twenty-eight studies met inclusion criteria. Pooled percentages of locoregional recurrences were significantly lower with CMA vs SA for all KCs (3.9% [95% CI: 2.9-4.9] vs 13.5% [7.7, 19.2, p = .001]), cutaneous squamous cell carcinoma with PNI (9.8% [5.4-14.1] vs 32.0% [25.0-39.0], p < .001), and recurrent BCC (4.4% [2.9-5.9] vs 11.9% [8.0-15.8], p < .001).
For high-risk KCs, recurrence risk was over 3-times greater with SA compared with CMA. Expanded access to CMA for high-risk KC is likely to reduce recurrence risk and improve clinical outcomes.
角朊细胞癌（KC）是全球最常见的诊断癌症，通常通过完全边缘评估（CMA）或切除分段评估（SA）进行切除。国家综合癌症网络指南鼓励对具有高危特征的 KC 进行 CMA。
根据国家综合癌症网络指南标准，系统比较高危 KC 中 CMA 与 SA 的复发结果。
在 EMBASE 和 MEDLINE 上搜索报道使用 CMA 或 SA 切除高危 KC 后复发的文章。高危 KC 定义为复发、有神经周围侵犯（PNI）或基底细胞癌（BCC）具有侵袭性组织学特征。卡方检验和风险比评估了 CMA 组和 SA 组之间的差异，并进行了随机效应荟萃分析。
28 项研究符合纳入标准。所有 KC（3.9%[95%CI：2.9-4.9]与 13.5%[7.7，19.2，p=.001]）、有 PNI 的皮肤鳞状细胞癌（9.8%[5.4-14.1]与 32.0%[25.0-39.0]，p<.001）和复发性 BCC（4.4%[2.9-5.9]与 11.9%[8.0-15.8]，p<.001）的局灶性复发百分比，CMA 显著低于 SA。
对于高危 KC，SA 的复发风险比 CMA 高 3 倍以上。扩大高危 KC 的 CMA 应用范围可能会降低复发风险并改善临床结果。
