Kyono Kaori, Tamada Yoshinori, Ara Michito, Yamagishi Shin-Ichiro, Higuchi Ayako, Iida Keiichiro, Wada Naoko, Mikami Makoto, Urushidate Satoshi
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan.
Department of Plastic Surgery, Aomori Rosai Hospital, 1 Minamigaoka, Shirogane, Hachinohe City, Aomori, 031-8551, Japan.
JPRAS Open. 2024 Nov 26;43:216-226. doi: 10.1016/j.jpra.2024.11.010. eCollection 2025 Mar.
Basal cell carcinoma is the most common skin malignancy. The standard treatment is surgical excision with predetermined margins. Some argue that the currently recommended surgical margins are excessive, and it is questionable whether such wide surgical margins should be applied to all lesions. We statistically investigated excisions with narrow margins and tried to identify the risk factors for recurrence after one-step surgery.
Basal cell carcinomas were excised at a single institute in Japan over a six-year period and the recurrence rates were retrospectively analyzed using pathological reports and case notes. We reviewed the microscopic findings of the excised specimens and examined the excisional margin status, tumor subtype, and perineural invasion.
Forty-eight basal cell carcinomas (45 primary and 3 recurrent) that were identified in Japanese patients were included in this study. Among the primary lesions, well-pigmented and well-defined lesions did not show any involvement of the surgical margins, perineural invasion, or development of local recurrence. Recurrent lesions were significantly associated with positive surgical margins (side margin, P<0.01; deep margin, P<0.01) during the primary operation; however, no association was found with local recurrence after re-resection. Significant differences were observed in perineural invasion and the tumor subtype, especially in the aggressive subtype (P<0.05).
A 2 mm margin allows for the safe excision of primary lesions with well-pigmented and well-defined basal cell carcinoma in Japan. Recurrent lesions can be treated with narrow margins by reconstruction after confirmation of a negative margin, instead of performing a common resection with wide margins.
基底细胞癌是最常见的皮肤恶性肿瘤。标准治疗方法是进行具有预定切缘的手术切除。一些人认为目前推荐的手术切缘过大，这种宽切缘是否应适用于所有病变值得怀疑。我们对窄切缘切除进行了统计学研究，并试图确定一期手术后复发的危险因素。
在日本的一家机构对基底细胞癌进行了为期六年的切除，并使用病理报告和病例记录对复发率进行回顾性分析。我们复查了切除标本的显微镜检查结果，并检查了切缘状态、肿瘤亚型和神经周围浸润情况。
本研究纳入了在日本患者中确诊的48例基底细胞癌（45例原发性和3例复发性）。在原发性病变中，色素沉着良好且边界清晰的病变未出现手术切缘受累、神经周围浸润或局部复发。复发性病变与初次手术时手术切缘阳性显著相关（侧切缘，P<0.01；深切缘，P<0.01）；然而，再次切除后与局部复发无相关性。在神经周围浸润和肿瘤亚型方面观察到显著差异，尤其是在侵袭性亚型中（P<0.05）。
在日本，2mm的切缘可安全切除色素沉着良好且边界清晰的原发性基底细胞癌病变。复发性病变在确认切缘阴性后可通过重建进行窄切缘治疗，而不是进行常规的宽切缘切除。
