Becker Philipp, Nahrstedt Sven, Pabst Andreas, Müller Gunnar, Bär Anne-Kathrin, Kämmerer Peer W, Al-Nawas Bilal, Werkmeister Richard
Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany; Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
J Craniomaxillofac Surg. 2025 Jan;53(1):57-65. doi: 10.1016/j.jcms.2024.10.008. Epub 2024 Nov 27.
This study aimed to identify factors influencing the completeness of primary and re-excision of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (SCC), and cutaneous carcinoma in situ (CIS) of the head and neck. A retrospective single-center analysis was conducted, encompassing 1513 instances of cutaneous tumors recorded between 2015 and 2022. This dataset comprised 1108 primary excisions and 405 re-excisions, all of which were histologically verified cases of BCC, SCC, and CIS located within the head and neck region. Correlation analyses were performed, considering variables such as patients' gender and age, tumor localization, preoperative suspicion or histological confirmation of skin tumor diagnosis, surgeons' levels of training, and the utilization of magnifying glasses. The primary objective was to assess the impact of these factors on the completeness of both primary and re-excisions of skin tumors. The analysis revealed a significant correlation between the localization of BCC and the completeness of primary excision. Specifically, the nose and ear exhibited a significantly higher rate of incomplete excisions (R1), whereas the cheek demonstrated a substantial reduction in the R1 rate. The utilization of magnifying glasses exhibited a positive correlation with the completeness of primary BCC excision. However, no discernible influencing factors were identified for BCC re-excisions and the combined group of primarily and re-excised cutaneous squamous cell carcinoma (SCC) and carcinoma in situ (CIS). Tumor entity and localization emerged as crucial factors influencing the completeness of skin tumor excisions, with specific anatomical sites exhibiting varying rates of incomplete procedures. Notably, the use of magnifying glasses demonstrated a significant positive correlation with reduced rates of incomplete excisions, re-excisions, and subsequent procedures, suggesting its potential as a valuable tool in enhancing surgical precision and optimizing outcomes.
本研究旨在确定影响头颈部基底细胞癌（BCC）、皮肤鳞状细胞癌（SCC）和皮肤原位癌（CIS）初次切除和再次切除完整性的因素。进行了一项回顾性单中心分析，涵盖2015年至2022年记录的1513例皮肤肿瘤病例。该数据集包括1108例初次切除和405例再次切除，所有病例均经组织学证实为头颈部区域的BCC、SCC和CIS。进行了相关性分析，考虑了患者的性别和年龄、肿瘤定位、术前对皮肤肿瘤诊断的怀疑或组织学确认、外科医生的培训水平以及放大镜的使用等变量。主要目的是评估这些因素对皮肤肿瘤初次和再次切除完整性的影响。分析显示，BCC的定位与初次切除的完整性之间存在显著相关性。具体而言，鼻子和耳朵的不完全切除率（R1）显著更高，而脸颊的R1率则大幅降低。放大镜的使用与BCC初次切除的完整性呈正相关。然而，未发现影响BCC再次切除以及皮肤鳞状细胞癌（SCC）和原位癌（CIS）初次和再次切除联合组的明显影响因素。肿瘤类型和定位是影响皮肤肿瘤切除完整性的关键因素，特定解剖部位的不完全手术率各不相同。值得注意的是，放大镜的使用与不完全切除、再次切除及后续手术率的降低显著正相关，表明其作为提高手术精度和优化手术效果的有价值工具的潜力。
