Optimal Surgical Safety Margin for Facial Basal Cell Carcinoma

Abstract

Objectives. The major objective of this study is to establish optimal surgical margin for facial primary basal cell carcinoma smaller than 2.3 cm in diameter. Recommendations for this type of skin tumors are for 4 mm surgical margin, but on the face there is a tendency to use smaller margins, for example 2-3 mm.

Material and Method. 38 patients with 40 primary facial basal cell carcinoma of less than 2.3 cm in diameter, nonsclerodermiform types, were included in the study. All tumors were initially excised with 2-3 mm surgical margin and all specimens were histologically evaluated using a total margin assessment method. If margins were found, positive reexcision was performed with an additional 2 mm margin. This process of reexcision and histological evaluation was performed until tumor free margins were obtained. Evaluation of tumor clearance and healthy tissue sparing was performed for both 2-3 and 4-5 mm safety surgical margins. For the statistical analysis the chi square test and statistical regression analysis were used.

Results. After the first excision, with 2-3 mm margins, 35% patients were free of tumor and 65% still had tumor infiltration of the margins. After the second excision, which meant a total of 4-5 mm of surgical excision margin, 92.5% patients were free of tumor. Excising a tumor with 4-5 mm surgical margin resulted in 49.55% healthy tissue and 50.45 % tumor tissue removal of the total excised tissue.

Conclusion. A surgical margin of 2-3 mm for primary non-complicated facial basal cell carcinoma of less than 2.3 cm in diameter is not recommended because of low tumor clearance and a high risk of recurrence. If a total margin assessment method is not available, then a 4-5 mm surgical margin should be used when treating primary, non-complicated facial basal cell carcinoma.