title: Reducing the learning curve for the treatment of morphoeic (sclerosing) basal cell carcinoma of the face.
abstract: The treatment of morphoeic (or sclerosing) basal cell carcinoma (mBCC) of the face is associated with high rates of incomplete excision and recurrence. A principal risk factor for incomplete resection is the grade of surgeon. We did a prospective, randomised study of 40 consecutive patients with mBCC of the face. The extent of the tumour was assessed under standard conditions by consultant surgeons and compared with assessments by resident surgeons with the help of the Varioscope, a combination of microscope and loupe glasses with strong illumination and a maximal magnification of 7x. The data from a former retrospective study of all excisions of mBCC of the face during a five-year period at the hospital served as control. Residents with the support of the Varioscope achieved a rate of incomplete excisions similar to that of consultants under standard conditions. There was a significant reduction of the rate of incomplete resections by resident surgeons thanks to high magnification and good lighting (p=0.02). High magnification and good lighting were useful in learning how to recognise skin changes associated with mBCC of the face and achieving a low rate of incomplete excisions.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, Switzerland. perba@uhbs.ch
authors.forename: Paolo
authors.initials: P
authors.lastname: Erba
authors.forename: Reto
authors.initials: R
authors.lastname: Wettstein
authors.forename: Ulrich M
authors.initials: UM
authors.lastname: Rieger
authors.forename: Helmut
authors.initials: H
authors.lastname: Beltraminelli
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002983:Clinical Competence; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008866:Microsurgery / Q000193:education* / Q000379:methods; D018365:Neoplasm, Residual / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000193:education*; D012878:Skin Neoplasms / Q000601:surgery*