Excision of head and neck basal cell carcinoma with a rapid, cross-sectional, frozen-section technique.
OBJECTIVE
To compare a rapid, cross-sectional frozen-section technique with Mohs micrographic surgery, using recurrence rate and cost of treatment for excision of basal cell carcinoma as indicators to validate our indications for Mohs surgery.


METHODS
Retrospective study of 557 head and neck basal cell carcinomas excised over 10 years.


METHODS
Recurrence rates; tumor comparisons by size, location, and subtype; a life table, and a patient satisfaction survey.


RESULTS
Recurrence rate for the cross-sectional technique was 2.1% at 5 years. Recurrent tumors had an average diameter of 1.56 cm (vs 1.04 cm for nonrecurrent tumors). Recurrences were in the cheek (30%), nose (20%), temple (20%), forehead/brow (10%), conchal bowl (10%), and postauricular crease (10%). Recurrences were nodular cystic (40%), micronodular (20%), multifocal (10%), and infiltrating (30%). A total of 86.6% of patients surveyed rated the aesthetic outcome of their surgery favorably. The cost compared with the cost of Mohs excision varied depending on the Current Procedural Terminology coding technique.


CONCLUSIONS
Cross-sectional frozen-section recurrence rates can compare favorably with Mohs micrographic surgery. The cross-sectional frozen-section technique generated a cost savings over Mohs surgery that may not hold true for all practice settings. Margin size did not adversely affect aesthetic results. Loupe magnification x2.5 is important in our technique. We also offer a useful definition for recurrence.
Bentkover
Stuart H
SH
Fallon Clinic, Worcester, MA 01604, USA. bentkov@quixnet.net
Grande
Donald M
DM
Soto
Henry
H
Kozlicak
Beth A
BA
Guillaume
Donna
D
Girouard
Sheila
S
D000368:Aged; D001706:Biopsy / Q000191:economics / Q000379:methods; D002280:Basal Cell Carcinoma / Q000191:economics / Q000473:pathology / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D005629:Frozen Sections / Q000191:economics / Q000379:methods; D006258:Head and Neck Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000191:economics / Q000379:methods; D009364:Neoplasm Recurrence, Local; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States