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Soo Park, MD
Soo Park, MD
Posted: Wednesday, July 31, 2024
The watch-and-wait approach in the histopathologic presence of basal cell carcinoma cells at one or more specimen margins after surgical excision—in other words, incompletely excised basal cell carcinoma—more likely results in clinical recurrence than does either immediate reexcision or adjuvant/complementary nonsurgical treatment. However, the outcome differences among the approaches did not seem to reach statistical significance, according to Maria Daviti, MD, of Aristotle University, Thessaloniki, Greece, and colleagues, whose retrospective study results appeared in the journal Dermatology.
Of 1,689 basal cell carcinomas treated over 5 years at a tertiary dermatology center in Greece, 84 had an available histopathologic assay reporting at least one lateral or deep-involved margin. Group 1’s patients (n = 26) had immediate reexcision; those in group 2 (n = 40) were followed with no additional therapy; and group 3’s patients (n = 18) were treated with adjuvant/complementary nonsurgical treatment (either imiquimod alone or cryotherapy; postsurgical radiotherapy was not an option at this center).
Clinical tumor recurrence occurred in 14 of 84 patients (16.7%), after a mean follow-up of 17 months: 2 patients in group 1 (7.7%), 10 in group 2 (25%), and 2 in group 3 (11.1%). The median time to recurrence was 14 months.
Also, the initial histopathologic reports of the 26 reexcised tumors of group 1 revealed residual tumor in 14 cases (53.8%). “This paradoxical finding might be explained by the tissue shrinkage occurring at the periphery of the specimen after surgical excision, the inflammatory host response scattered by the… diathermocoagulation/surgical treatment, or postsurgery activation of the immune system and cytotoxic activity of T cells targeting the remaining neoplastic cells,” they hypothesized.
They added that 7 of the 14 recurrent basal cell carcinomas were located on the nose. However, recurrence was not statistically significantly associated with anatomic site or any other factors such as initial basal cell carcinoma size, histopathologic subtype, or patient age.
Disclosure: The study authors reported no conflicts of interest.
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