Re-excision of incompletely excised cutaneous squamous cell carcinoma: histological findings influence prognosis.
BACKGROUND
We have previously shown 28.6% of re-excisions for margin-positive cutaneous SCC to yield residual tumour (positive re-excision). Original tumour diameter and thickness conferred significant risks for positive re-excision. We now report a 5-year prospective follow-up of our re-excision cohort.


RESULTS
Of 676 consecutive SCC patients, 84 underwent wider-excision for positive margins. 79 of these patients completed a mean of 28 months follow-up. Overall, 9/79 (11%) of this re-excision cohort experienced locoregional recurrence, all within 2 years of primary resection. Of the positive re-excisions, 29% experienced recurrence, vs 5% in those with negative re-excisions. Logistic-regression analysis revealed positive re-excision to predict recurrence (P<0.05, RR 10.1), independent from tumour-grade, anatomical site, size, and delay to re-excision.


CONCLUSIONS
Factors associated with residual tumour on re-excision are similar to characteristics of high-risk SCCs; larger tumours in particular are more likely to persist and may benefit from wider excision-margins at original resection. Positive re-excision is newly identified as a significant risk for locoregional recurrence, whilst negative re-excision is associated with a return to a low-risk prognosis, for all tumours. Our findings thus support the treatment of cutaneous SCC through to completion. We also recommend re-excision where narrow or close margins are reported. Patients with a positive re-excision should be considered at high risk for recurrence, requiring extended follow-up.
Royal Devon & Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. ebovill@doctors.net.uk
Esta S
ES
Bovill
Paul E
PE
Banwell
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom