Lee Sang-Oh, Kim Tae Gon, Chung Kyu Jin
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Arch Plast Surg. 2024 Dec 27;52(1):30-35. doi: 10.1055/s-0044-1788780. eCollection 2025 Jan.
Basal cell carcinoma (BCC) is the predominant nonmelanocytic skin cancer, with preservation of both function and aesthetics being essential during tumor removal. Existing surgical margin guidelines primarily target ill-defined BCCs prevalent in Western countries. Therefore, this study aims to demonstrate the efficacy of surgical removal, propose modified guidelines for wide excision tailored to Asian patients, and share experiences with various reconstruction methods. This study encompasses 418 patients (447 cases) who underwent BCC excision from March 2015 to June 2023 at our institution. Wide excision extended 2 mm beyond the tumor edge universally, with an additional 2 mm resected if tumor cells persisted in the frozen biopsy, followed by appropriate reconstruction. Patient demographics, tumor features, reconstruction methods, complications, and recurrence rates were analyzed. Predominantly, reconstructions involved local flaps (244), skin grafts (102), and direct closure (72). Significant differences were noted in age, location, and tumor size among these groups. The rate of second resection increased from upper to lower facial subunits, peaking at 11.1% in the lower subunit, with a statistically significant difference ( = 0.024). Additional resection was required in 5.50% of cases, with a significantly higher incidence of ill-defined borders, pigmentation, and the infiltrative subtype compared with others. Complications were minor; recurrence occurred in only one case, 6 months postinitial nasal dorsum surgery. Surgical excision is highly effective, supported by various reconstruction options. We propose narrower guidelines for wide excision considering tumor characteristics and recurrence locations, resulting in smaller defects addressed with simpler reconstruction methods.
基底细胞癌（BCC）是最主要的非黑素细胞性皮肤癌，在肿瘤切除过程中保留功能和美观至关重要。现有的手术切缘指南主要针对西方国家常见的边界不清的基底细胞癌。因此，本研究旨在证明手术切除的疗效，提出针对亚洲患者的改良广泛切除指南，并分享各种重建方法的经验。
本研究纳入了2015年3月至2023年6月在我院接受基底细胞癌切除的418例患者（447例病例）。广泛切除普遍在肿瘤边缘外扩展2毫米，如果冰冻活检中仍有肿瘤细胞，则再切除2毫米，随后进行适当的重建。分析了患者的人口统计学特征、肿瘤特征、重建方法、并发症和复发率。
主要的重建方法包括局部皮瓣（244例）、皮肤移植（102例）和直接缝合（72例）。这些组在年龄、部位和肿瘤大小方面存在显著差异。二次切除率从面部上亚单位到下亚单位逐渐增加，在下亚单位达到峰值11.1%，差异有统计学意义（P = 0.024）。5.50%的病例需要额外切除，与其他病例相比，边界不清、色素沉着和浸润性亚型的发生率显著更高。并发症轻微；仅1例在初次鼻背手术后6个月复发。
手术切除非常有效，有多种重建选择支持。我们根据肿瘤特征和复发部位提出更窄的广泛切除指南，从而用更简单的重建方法处理更小的缺损。
