Yildizdal Suleyman, Kucukguven Arda, Calis Mert, Vargel Ibrahim
Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey.
Ankara Training and Research Hospital Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3390-3397. doi: 10.1016/j.bjps.2022.06.013. Epub 2022 Jun 17.
Basal cell carcinoma (BCC) is the most common skin cancer. Removing the lesion with wide surgical margins and obtaining a microscopically intact margin is considered sufficient in the treatment of BCC. However, it may not always be possible to provide wide and intact margins in cosmetically and functionally important areas. Although recurrence rates after BCC excision vary among studies, the recurrence rate at 5 years is considered to be 2%. BCC subtype, perineural invasion, and close margin are important factors in recurrence. The aims of this study are to investigate the other factors associated with recurrence in BCC treatment and reveal the value of the "histopathological surgical margin" which can help in making the decision for re-excision. A statistically significant correlation is observed between the increase in tumour size and recurrence(p<0.05). The recurrence rate after excision with a histopathologic margin of 1 mm or less is 19%. This rate is found to be 8% in patients with a histopathological margin greater than 1 mm and 3 mm or less. Reticular dermis and deeper tissue invasion statistically increase the recurrence rate. Multiple excision and the presence of residual tumour in the re-excision sample also increase the recurrence rate. In conclusion, recurrence in BCC patients is affected by more than one parameter. We highly recommend re-excision in patients with a histopathological margin of 1 mm or less. In tumours with histopathological margins between 1 mm and 3 mm, the decision for re-excision or "wait-and-see" approach should be made according to the characteristics of the tumours and patients.
基底细胞癌（BCC）是最常见的皮肤癌。在BCC的治疗中，通过广泛的手术切缘切除病变并获得显微镜下完整的切缘被认为是足够的。然而，在美容和功能重要区域，可能并不总是能够提供广泛且完整的切缘。尽管BCC切除术后的复发率在不同研究中有所差异，但5年复发率被认为是2%。BCC亚型、神经周围浸润和切缘接近是复发的重要因素。本研究的目的是调查BCC治疗中与复发相关的其他因素，并揭示有助于做出再次切除决策的“组织病理学手术切缘”的价值。观察到肿瘤大小增加与复发之间存在统计学显著相关性（p<0.05）。组织病理学切缘为1毫米或更小的切除术后复发率为19%。在组织病理学切缘大于1毫米且小于或等于3毫米的患者中，这一比率为8%。网状真皮和更深层组织浸润在统计学上增加了复发率。多次切除以及再次切除样本中存在残留肿瘤也会增加复发率。总之，BCC患者的复发受多个参数影响。我们强烈建议对组织病理学切缘为1毫米或更小的患者进行再次切除。对于组织病理学切缘在1毫米至3毫米之间的肿瘤，应根据肿瘤和患者的特征决定是否再次切除或采取“观察等待”方法。
