title: Staged surgical therapy of basal cell carcinoma of the head and neck region: an evaluation of 500 procedures.
abstract: OBJECTIVE
  The surgical therapy of basal cell carcinoma (BCC) is especially demanding in the facial area. This retrospective study was undertaken to evaluate the outcome of staged surgical therapy (SST) of BCC of the head and neck region performed on an interdisciplinary basis at our institution.
  
  
  METHODS
  Patients treated for BCC in the head and neck area between 1/1/1997 and 31/12/2001 were included in the study. The lesions were histologically evaluated. Diameter of lesion, number of stages, defect coverage, operation time, and recurrence and infection rates were analysed using descriptive and inferential statistical procedures.
  
  
  RESULTS
  281 patients were included in the study. SST was performed in two stages in 43.7%, in three stages in 12.9% and in four or more stages in 2.7%, depending on the type of tumour and the patient's pretreatment status. The total operating time per lesion averaged one hour. Defect coverage was achieved by direct closure (37.7%), by full thickness skin graft (39.5%), by split skin graft (1.1%), by local flaps (20.3%) or by composite grafts (1.1%). Median follow-up time was 58.5 months. Low rates of recurrence (3.6%) and infection (2%) were observed with this technique.
  
  
  CONCLUSIONS
  The staged surgical therapy of basal cell carcinoma evaluated here offers a series of advantages in respect of patient comfort and safety and economy, while allowing precise histological safety with low infection rates and reliable long-term results.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital, Inselspital, Bern, Switzerland. rolf.huesler@insel.ch
authors.forename: Rolf
authors.initials: R
authors.lastname: Hüsler
authors.forename: Fabian L
authors.initials: FL
authors.lastname: Schlittler
authors.forename: Janett
authors.initials: J
authors.lastname: Kreutziger
authors.forename: Markus
authors.initials: M
authors.lastname: Streit
authors.forename: Andrej
authors.initials: A
authors.lastname: Banic
authors.forename: Franziska
authors.initials: F
authors.lastname: Schöni-Affolter
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hunger
authors.forename: Mihai A
authors.initials: MA
authors.lastname: Constaninescu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome