Postsurgical Positive Margins Top Indicator of BCC Recurrence

Findings from a new study show positive surgical margins among patients who have basal cell carcinoma (BCC) to be the strongest indicator of disease recurrence among these patients, particularly if the cancer occurs in the head and neck region. Because of this, the investigators have issued caution on the use of surgical excision among high-risk patients.

Their findings published recently in Polish Otolaryngology.

There were 545 patients covered by their retrospective analysis of head and neck primary BCC treated between 2008 and 2018; any patients with a history of disease recurrence were excluded. Their mean (SD) overall age was 69 (12.17) years, and 55% were male patients.

“There are several methods of BCC treatment although surgical excision remains the gold standard. Treatment results are fairly good; the local recurrence risk is between 3% and 12%,” the authors wrote. “Nevertheless with such high incidence rates, recurrence is a problem for the patient.”

Overall, 52 patients in the study eventually developed local disease recurrence, and of these 53.85% were male patients. Twenty-seven percent had positive surgical margins. This finding was associated with the highest increased risk of disease recurrence, 571%, compared with clear margins (odds ratio [OR], 6.71; 95% CI, 3.69-122; P < .001).

The most common site of tumor location was the nose, at 30.2%, followed by auricle, at 21.8%, and nodular was the most common subtype, at 21.8%. When stratifying these tumors by size (>20 or ≤20 mm), 72.2% were smaller than 20 mm.

The authors’ analysis also found additional factors associated with higher and lower risks of BCC disease recurrence:

• Factors associated with a lower risk were the following:
  • Eyelid location: 39% (OR, 0.61; 95% CI, 0.24-1.60; P = .3201)
  • Cheek and temple location: 46% (OR, 0.54; 95% CI, 0.21-1.41; P = .2098)
  • Ear location: 14% (OR, 0.86; 95% CI, 0.40-1.85; P = .7029)
• Factors associated with a higher risk were the following:
  • Age older than 70 years: 23% (OR, 1.23; 95% CI, 0.69-2.18; P = .4881)
  • Forehead and scalp location: 46% (OR, 1.46; 95% CI, 0.6-3.58; P = .4039)
  • Tumor size greater than 20 mm: 57% (OR, 1.57; 95% CI, 0.87-2.87; P = .5151)
  • Superficial subtype: 109% (OR, 2.09; 95% CI, 0.23-19.33)
  • Infiltrative/invasive subtype: 124% (OR, 2.24; 95% CI, 0.65-7.74; P = .2014)
  • Morpheaform subtype: 371% (OR, 4.71; 95% CI, 0.45-48.88; P = .1944)

The authors noted that their finding of an almost 7-fold increase in disease recurrence risk with positive surgical margins echoes previous research.

“The results of our study have shown that positive surgical margin remains the strongest risk factor for local recurrence,” they concluded. “With surgical excision being the gold standard of treatment, the greatest emphasis should be placed on avoiding such a scenario in high-risk patients with facial location, infiltrative and morpheaform subtype, and those with tumor size greater than 20 mm.”

Reference

Szewczyk M, Pazdrowski J, Pabiszczak M, Więckowska, Dańczak-Pazwrowska A, Golusiński W. Local recurrence risk in head and neck basal cell carcinoma. Otolaryngol Pol. 2022;76(4):1-5. doi:10.5604/01.3001.0015.8568