Basal cell carcinoma of the head and neck Region, a retrospective analysis

During the last years multiple studies have analysed the follow-up after resection of basalcellcarcinoma (BCC) giving different advice on whether to re-resect after R1-status and if not, which pivotal arguments led to this decision. The present study is a survey of 171 patients undergoing surgery to remove 191 BCCs of the skin in the head and neck region to answer these questions: whether a R0-resection should always be enforced or if a surgical closure with a persistent R1-situation can be acceptable. The retrospective study included patients from January 2009 to December 2013 with an average follow-up of 2,4 years. 29 reresections were done showing residual tumor cells in only 7 histopathological results (24,1%). In 46 cases (24,1%) a surgical closure was done with a still persistent R1-status. In 65,2% of these cases (n = 30) the histological subtype was a nodular, solid BCC, followed by a BCC of the sclerosing and infiltrative type in 17,4%. Most R1resections where localized at the ear (34,8%), the nose (30,4%) and the periorbital region (15,2%). In the follow-up three recurrences occurred (1,6%), all of them emerging after R1- resection (3 in 46 cases, i.e. 6,5%) and after removal of a solid nodular BCC on the nose (2/3) and in the periorbital region (1/3). The average period between removal of the primary tumor and the recurrence was three years.

The question whether to enforce a R0-status is a question of the tumor localization and the width of the infiltrated resection margin. Our study shows that even with a persistent R1-situation the rate of recurrence of BCC is low, allowing us to opt for a surgical coverage in such cases particularly when the localization makes a reresection difficult and the histological result is uncertain concerning residual tumor cells.

Publication History

Publication Date:
18 April 2018 (online)