Archives of Plastic Surgery

  • 제52권1호
  • /
  • Pages.30-35
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  • 2025
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Minimizing Surgical Margins in Basal Cell Carcinoma: A Single Institution's Experience with Excision and Reconstruction Methods

  • Sang-Oh Lee (Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine) ;
  • Tae Gon Kim (Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine) ;
  • Kyu Jin Chung (Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine)
  • 투고 : 2024.01.22
  • 심사 : 2024.07.13
  • 발행 : 2025.01.15
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초록

Background Basal cell carcinoma (BCC) is the predominant nonmelanocytic skin cancer, with preservation of both function and aesthetics being essential during tumor removal. Existing surgical margin guidelines primarily target ill-defined BCCs prevalent in Western countries. Therefore, this study aims to demonstrate the efficacy of surgical removal, propose modified guidelines for wide excision tailored to Asian patients, and share experiences with various reconstruction methods. Methods This study encompasses 418 patients (447 cases) who underwent BCC excision from March 2015 to June 2023 at our institution. Wide excision extended 2 mm beyond the tumor edge universally, with an additional 2 mm resected if tumor cells persisted in the frozen biopsy, followed by appropriate reconstruction. Patient demographics, tumor features, reconstruction methods, complications, and recurrence rates were analyzed. Results Predominantly, reconstructions involved local flaps (244), skin grafts (102), and direct closure (72). Significant differences were noted in age, location, and tumor size among these groups. The rate of second resection increased from upper to lower facial subunits, peaking at 11.1% in the lower subunit, with a statistically significant difference (p = 0.024). Additional resection was required in 5.50% of cases, with a significantly higher incidence of ill-defined borders, pigmentation, and the infiltrative subtype compared with others. Complications were minor; recurrence occurred in only one case, 6 months postinitial nasal dorsum surgery. Conclusion Surgical excision is highly effective, supported by various reconstruction options. We propose narrower guidelines for wide excision considering tumor characteristics and recurrence locations, resulting in smaller defects addressed with simpler reconstruction methods.

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과제정보

This work was supported by the 2023 Yeungnam University Research Grant.

참고문헌

  1. Mohapatra DP, Friji MT, Dinesh Kumar S, Chittoria RK, Pathan I, Koliath S. Reconstruction of defects following excision of basal cell carcinoma of face: a subunit-based algorithm. J Cutan Aesthet Surg 2023;16(01):1–13 https://doi.org/10.4103/JCAS.JCAS_87_21
  2. Kasumagic-Halilovic E, Hasic M, Ovcina-Kurtovic N. A clinical study of basal cell carcinoma. Med Arh 2019;73(06):394–398 https://doi.org/10.5455/medarh.2019.73.394-398
  3. Gellatly M, Cruzval-O'Reilly E, Mervak JE, Mervak BM. Metastatic basal cell carcinoma with atypical pattern of spread. Radiol Case Rep 2020;15(12):2641–2644 https://doi.org/10.1016/j.radcr.2020.09.054
  4. Krakowski AC, Hafeez F, Westheim A, Pan EY, Wilson M. Advanced basal cell carcinoma: what dermatologists need to know about diagnosis. J Am Acad Dermatol 2022;86(6S):S1–S13 https://doi.org/10.1016/j.jaad.2022.03.023
  5. McDaniel B, Badri T, Steele RB. Basal Cell Carcinoma. Treasure Island, FL: StatPearls Publishing LLC; 2023
  6. Cameron MC, Lee E, Hibler BP, et al. Basal cell carcinoma: epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol 2019;80(02):303–317 https://doi.org/10.1016/j.jaad.2018.03.060
  7. Laga AC, Schaefer IM, Sholl LM, French CA, Hanna J. Metastatic basal cell carcinoma. Am J Clin Pathol 2019;152(06):706–717 https://doi.org/10.1093/ajcp/aqz089
  8. Hernandez LE, Mohsin N, Levin N, Dreyfuss I, Frech F, Nouri K. Basal cell carcinoma: An updated review of pathogenesis and treatment options. Dermatol Ther 2022;35(06):e15501 https://doi.org/10.1111/dth.15501
  9. Glud M, Omland SH, Paoli J, et al. [Mohs surgery for basal cell carcinoma]. Ugeskr Laeger 2017;179:V07160501
  10. Ento Key. 5 Reference Points in Aesthetic Facial Surgery: Part Mathematics, Part Intuition. The Nose-Revision & Reconstruction 2016. Doi: 10.1055/b-0035-121683
  11. Lanoue J, Goldenberg G. Basal cell carcinoma: a comprehensive review of existing and emerging nonsurgical therapies. J Clin Aesthet Dermatol 2016;9(05):26–36
  12. Wong E, Axibal E, Brown M. Mohs micrographic surgery. Facial Plast Surg Clin North Am 2019;27(01):15–34 https://doi.org/10.1016/j.fsc.2018.08.002
  13. Heath MS, Bar A. Basal cell carcinoma. Dermatol Clin 2023;41(01):13–21 https://doi.org/10.1016/j.det.2022.07.005
  14. Mosterd K, Krekels GA, Nieman FH, et al. Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up. Lancet Oncol 2008;9(12):1149–1156 https://doi.org/10.1016/S1470-2045(08)70260-2
  15. Nakamura Y, Matsushita S, Tanaka R, et al. 2-mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas. J Eur Acad Dermatol Venereol 2020;34(09):1991–1998 https://doi.org/10.1111/jdv.16200
  16. Ito T, Inatomi Y, Nagae K, et al. Narrow-margin excision is a safe, reliable treatment for well-defined, primary pigmented basal cell carcinoma: an analysis of 288 lesions in Japan. J Eur Acad Dermatol Venereol 2015;29(09):1828–1831 https://doi.org/10.1111/jdv.12689
  17. Kamimura A, Nakamura Y, Takenouchi T, et al. Concordance in judgment of clinical borders of basal cell carcinomas in Japanese patients: a preliminary study of JCOG2005 (J-BASE-MARGIN). J Dermatol 2022;49(09):837–844 https://doi.org/10.1111/1346-8138.16422
  18. Matsushita S, Nakamura Y, Tanaka R, et al. Prediction of the invasive level of basal cell carcinomas in the facial area: Analysis of 718 Japanese cases. J Dermatol Sci 2020;99(03):152–157 https://doi.org/10.1016/j.jdermsci.2020.07.001
  19. Quazi SJ, Aslam N, Saleem H, Rahman J, Khan S. Surgical margin of excision in basal cell carcinoma: a systematic review of literature. Cureus 2020;12(07):e9211 https://doi.org/10.7759/cureus.9211
  20. Kim ES, Yang CE, Chung YK. Does reduction of the oncologic safety margin for facial basal cell carcinoma result in higher recurrence rates? Arch Craniofac Surg 2021;22(03):135–140 https://doi.org/10.7181/acfs.2021.00206
  21. Huang L, Wang X, Pei S, et al. Single-cell profiling reveals sustained immune infiltration, surveillance, and tumor heterogeneity in infiltrative basal cell carcinoma. J Invest Dermatol 2023;143(11):2283–2294.e17 https://doi.org/10.1016/j.jid.2023.04.020
  22. Reiter O, Mimouni I, Dusza S, Halpern AC, Leshem YA, Marghoob AA. Dermoscopic features of basal cell carcinoma and its subtypes: a systematic review. J Am Acad Dermatol 2021;85(03):653–664 https://doi.org/10.1016/j.jaad.2019.11.008