CBC > 2 cm

Factors Predictive of Recurrence, Metastasis, and Death from Primary BCC ≥2 cm

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• This retrospective study identified risk factors which are independently associated with local recurrence (LR) and metastasis and/or death (M/D) in patients with large (≥2 cm) basal cell carcinoma (BCC). Patients with large BCC tumors (n=248) had a significantly higher risk of local recurrence and metastasis and/or death compared with those with small BCC tumors (n=248). Head and neck location (OR, 9.7), Mohs micrographic surgery (OR, 0.14), and depth beyond fat (OR, 3.1) were the risk factors associated with local recurrence in patients with large BCC. Significant predictors of metastasis and/or death among patients with large BCC included head and neck location (OR, 5.3), tumor diameter ≥4 cm (OR, 11.9), and depth beyond fat (OR, 28.6).

• Not surprisingly, patients with large BCC had significantly higher risk of local recurrence and metastasis/death. The considerable magnitude of increase in recurrence and metastasis/death in these patients calls for optimization of management.

– InYoung Kim, MD, PhD

Abstract 

BACKGROUND

Basal cell carcinoma (BCC) recurrence and metastatic rates are known to be very low. The risk factors for these rare outcomes are subsequently not well-studied.

OBJECTIVE

To identify risk factors independently associated with local recurrence (LR) and metastasis and/or death (M/D) in large (≥2cm) BCC METHODS: BCCs histologically confirmed between 2000 and 2009 were retrospectively screened for tumor diameter at two academic centers. Medical records of all large BCC and an equal number of randomly-selected small BCC were reviewed for LR and M/D.

RESULTS

248 large BCC and 248 small BCC tumors were included. Large BCC had a significantly higher risk of LR and M/D compared to small BCC (LR: 8.9% vs. 0.8%, p<0.001; M/D: 6.5% vs. 0%, p<0.001). Since the risks were so low in small BCC, they were excluded from further analysis. On multivariable logistic regression, head/neck location (odds ratio, 9.7 [95% CI, 3.0-31.3]), Mohs micrographic surgery (0.14 [0.04-0.5]), and depth beyond fat (3.1 [1.0-9.6]) were associated with LR in large BCC. Head/neck location (5.3 [1.2-23.2]), tumor diameter ≥4cm (11.9 [2.4-59.4]), and depth beyond fat (28.6 [6.7-121]) were significant predictors of M/D in large BCC.

LIMITATIONS

Retrospective cohort design CONCLUSIONS: Large BCC, particularly those with additional risk factors, have a high enough risk of recurrence and metastasis to warrant further investigation to optimize management.

Journal of the American Academy of Dermatology

Factors Predictive of Recurrence, Metastasis, and Death from Primary Basal Cell Carcinoma 2 cm or Larger in Diameter

J Am Acad Dermatol 2019 Oct 07;[EPub Ahead of Print], FC Morgan, ES Ruiz, PS Karia, RJ Besaw, VA Neel, CD Schmults

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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