title: Excision of head and neck basal cell carcinoma with a rapid, cross-sectional, frozen-section technique.
abstract: 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.
authors.affiliation: Fallon Clinic, Worcester, MA 01604, USA. bentkov@quixnet.net
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Bentkover
authors.forename: Donald M
authors.initials: DM
authors.lastname: Grande
authors.forename: Henry
authors.initials: H
authors.lastname: Soto
authors.forename: Beth A
authors.initials: BA
authors.lastname: Kozlicak
authors.forename: Donna
authors.initials: D
authors.lastname: Guillaume
authors.forename: Sheila
authors.initials: S
authors.lastname: Girouard
mesh_terms: 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