Background. Basal cell carcinoma comprises the vast majority of skin cancers. It predominantly affects fair-skinned individuals, and its incidence is rising rapidly. Etiology may be multifactorial, but sun exposure appears to play a critical role. When detected early, the prognosis is excellent. Thus appropriate diagnosis, treatment, and surveillance are of utmost importance. Methods. From January 1994 to May 2012, 518 basal cell carcinomas were excised in our clinic. Data were collected retrospectively. Results. During 18-year period, 518 BCCs were excised from 486 patients. Most of the patients were males with a median age of 65.6 years. Most of the basal cell carcinomas were located in the head region. Nodular histological subtype dominated our series. Six percent of the excised lesions required reexcision because of involved margins. Our recurrence rate was 6.94% with the nose and the periauricular and periocular regions being the most common sites of occurrence. Conclusion. Although there is relatively low attributable mortality, the morbidity and cost of treatment are significant. A large body of information serves as a foundation for oncologic principles, diagnosis methods, surgical excisions, follow-up protocols, and reconstructive methodologies that are currently in use. Surgical ablation remains the mainstay of treatment. 1. Introduction Basal cell carcinoma (BCC) is a malignant epithelial neoplasm that originates from the pluripotential cells in the epidermis and hair follicles [1]. It is the most common skin cancer seen in human population [2]. It is often slow growing and may take years to enlarge significantly [3], but it can cause extensive local tissue destruction and slow death if inadequately treated or left untreated. The mortality rates associated with this cancer are low. However, it causes considerable functional and cosmetic deformity and cost of treatment is significant. In this study, we aimed to share our experience in the management of these tumors. 2. Methods Our BCC database was reviewed between 1994 and 2012. Variables collected by operating surgeon were the patient’s age, sex, tumor site, size, histologic subtype, surgical margin of excision, multiplicity of lesions, presence of involved margins, recurrence during followup, and the presence of metastasis. All of the pathology specimens were examined and reported by the Department of Pathology at our center. 3. Results 3.1. Age and Sex From January 1994 to May 2012, 518 BCCs were excised from 486 patients. The median age was 65.6 (range of 20 to 93 years), 182 patients were
References
[1]
H. Pinkus, “Premalignant fibroepithelial tumors of skin,” Archives of Dermatology and Syphilology, vol. 67, no. 6, pp. 598–615, 1953.
[2]
A. Jemal, T. Murray, A. Samuels, A. Ghafoor, E. Ward, and M. J. Thun, “Cancer statistics, 2003,” CA: A Cancer Journal for Clinicians, vol. 53, no. 1, pp. 5–26, 2003.
[3]
R. I. Zbar and W. I. Cottle, “Skin tumors I: nonmelanoma skin tumors,” Selected Readings in Plastic Surgery, vol. 9, article 5, 2000.
[4]
H. F. Blum, “Sunlight as a causal factor in cancer of the skin of man,” Journal of the National Cancer Institute, vol. 9, no. 3, pp. 247–258, 1948.
[5]
H. M. Gloster and D. G. Brodland, “The epidemiology of skin cancer,” Dermatologic Surgery, vol. 22, no. 3, pp. 217–226, 1996.
[6]
A. J. J. Emmett, W. Austin, and G. Page, The Bare Fact: The Effect of Sun on Skin, Williams & Wilkins, Baltimore, Md, USA, 1988.
[7]
B. Modan, H. Mart, D. Baidatz, et al., “Radiation induced head and neck tumours,” The Lancet, vol. 303, no. 7852, pp. 277–279, 1974.
[8]
S. S. Strom and Y. Yamamura, “Epidemiology of nonmelanoma skin cancer,” Clinics in Plastic Surgery, vol. 24, pp. 627–636, 1997.
[9]
L. B. Shanoff, M. Spira, and S. B. Hardy, “Basal cell carcinoma: a statistical approach to rational management,” Plastic and Reconstructive Surgery, vol. 39, no. 6, pp. 619–624, 1967.
[10]
T. R. Wade and A. B. Ackerman, “The many faces of basal-cell carcinoma,” Journal of Dermatologic Surgery and Oncology, vol. 4, pp. 23–28, 1978.
[11]
M. Sexton, D. B. Jones, and M. E. Maloney, “Histologic pattern analysis of basal cell carcinoma: study of a series of 1039 consecutive neoplasms,” Journal of the American Academy of Dermatology, vol. 23, no. 6 I, pp. 1118–1126, 1990.
[12]
E. B. Russell, P. R. Carrington, and B. R. Smoller, “Basal cell carcinoma: a comparison of shave biopsy versus punch biopsy techniques in subtype diagnosis,” Journal of the American Academy of Dermatology, vol. 41, no. 1, pp. 69–71, 1999.
[13]
R. P. Pascal, L. W. Hobby, R. Lattes, et al., “Prognosis of “incompletely excised” versus “completely excised” basal cell carcinoma,” Plastic and Reconstructive Surgery, vol. 41, no. 4, pp. 328–332, 1968.
[14]
D. L. Shriner, D. K. McCoy, D. J. Goldberg, et al., “Mohs' micrographic surgery,” Journal of the American Academy of Dermatology, vol. 39, no. 1, pp. 79–97, 1998.
[15]
C. M. Lawrence, “Mohs' micrographic surgery for basal cell carcinoma,” Clinical and Experimental Dermatology, vol. 24, no. 2, pp. 130–133, 1999.
[16]
M. Anscher and G. Montano, “Radiotherapy,” Survey of Ophthalmology, vol. 38, no. 2, pp. 203–212, 1993.
[17]
A. J. J. Emmett, “Basal cell carcinoma,” in Malignant Skin Tumors, A. J. J. Emmett and M. G. E. O'Rourke, Eds., pp. 109–127, Churchill Livingstone, Edinburgh, UK, 2nd edition, 1991.
[18]
T. Dieu and A. M. Macleod, “Incomplete excision of basal cell carcinomas: a retrospective audit,” Australian and New Zealand Journal of Surgery, vol. 72, no. 3, pp. 219–221, 2002.
[19]
J. D. Richmond and R. M. Davie, “The significance of incomplete excision in patients with basal cell carcinoma,” British Journal of Plastic Surgery, vol. 40, no. 1, pp. 63–67, 1987.
[20]
R. W. Griffiths, “Audit of histologically incompletely excised basal cell carcinomas: recommendations for management by re-excision,” British Journal of Plastic Surgery, vol. 52, no. 1, pp. 24–28, 1999.
[21]
L. A. E. Sussman and D. F. Liggins, “Incompletely excised basal cell carcinoma: a management dilemma?” Australian and New Zealand Journal of Surgery, vol. 66, no. 5, pp. 276–278, 1996.
[22]
A. S. Y. Mak, A. M. S. Poon, C. Y. Leung, K. H. Kwan, T. T. Wong, and M. K. Tung, “Audit of basal cell carcinoma in Princess Margaret Hospital, Hong Kong: usefulness of frozen section examination in surgical treatment,” Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, vol. 29, no. 2, pp. 149–152, 1995.
[23]
F. Schreuder and B. W. Powell, “Incomplete excision of basal cell carcinomas: an audit,” Clinical Performance and Quality Health Care, vol. 7, no. 3, pp. 119–120, 1999.
[24]
J. J. Rippey and E. Rippey, “Characteristics of incompletely excised basal cell carcinomas of the skin,” Medical Journal of Australia, vol. 166, no. 11, pp. 581–583, 1997.
[25]
D. J. Hauben, H. Zirkin, D. Mahler, and M. Sacks, “The biologic behavior of basal cell carcinoma: analysis of recurrence in excised basal cell carcinoma: part II,” Plastic and Reconstructive Surgery, vol. 69, no. 1, pp. 110–116, 1982.
[26]
M. Hussain and M. J. Earley, “The incidence of incomplete excision in surgically treated basal cell carcinoma: a retrospective clinical audit,” Irish Medical Journal, vol. 96, no. 1, pp. 18–20, 2003.
[27]
A. Bogdanov-Berezovsky, A. Cohen, R. Glesinger, E. Cagnano, Y. Krieger, and L. Rosenberg, “Clinical and pathological findings in reexcision of incompletely excised basal cell carcinomas,” Annals of Plastic Surgery, vol. 47, no. 3, pp. 299–302, 2001.
[28]
D. P. Goldberg, “Assessment and surgical treatment of basal cell skin cancer,” Clinics in Plastic Surgery, vol. 24, no. 4, pp. 673–686, 1997.
[29]
R. E. Grimwood, C. F. Ferris, D. B. Mercill, and J. C. Huff, “Proliferating cells of human basal cell carcinoma are located on the periphery of tumor nodules,” Journal of Investigative Dermatology, vol. 86, no. 2, pp. 191–194, 1986.
[30]
H. W. Randle, “Basal cell carcinoma: identification and treatment of the high risk patient,” Dermatologic Surgery, vol. 22, no. 3, pp. 255–261, 1996.
