title: Surgical management of incompletely excised basal cell carcinomas of the head and neck.
abstract: We made a retrospective audit of all basal cell carcinomas excised in the Maxillofacial Units at St. Richard's Hospital, Chichester and the Worthing and Southlands NHS Trust between 1990 and 1999. A total of 3795 BCCs were excised. Of these, 3560 were completely excised (93.8%) and 235 were incompletely excised (6.2%), which compares favourably with other series. Of these, 84 patients had further excision, 11 had radiotherapy, and 140 were kept under review. Residual tumour was present in 45% of the re-excised specimens. Of the 140 cases managed by observation, 21% recurred. Notably, 31% of patients in the observation cohort died of other causes without recurrence. Incomplete excision was significantly more likely (P < 0.001) if multiple lesions were excised at the time of operation. Involvement of multiple margins was not a significant risk factor for recurrence in the 'observed' cohort. This study shows that a flexible strategy, which balances observation, further excision and radiotherapy, is superior to any single approach.
authors.affiliation: Maxillofacial Unit, St. Richards Hospital, Royal West Sussex Trust, Spitalfield Road, Chichester, West Sussex PO19 4SE, UK. Alan.Wilson@rws-tr.co.uk
authors.forename: A W
authors.initials: AW
authors.lastname: Wilson
authors.forename: G
authors.initials: G
authors.lastname: Howsam
authors.forename: V
authors.initials: V
authors.lastname: Santhanam
authors.forename: D
authors.initials: D
authors.lastname: Macpherson
authors.forename: J
authors.initials: J
authors.lastname: Grant
authors.forename: C A
authors.initials: CA
authors.lastname: Pratt
authors.forename: J V
authors.initials: JV
authors.lastname: Townend
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery*; D015331:Cohort Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D018365:Neoplasm, Residual / Q000532:radiotherapy / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors