Local Recurrence of BCCs Following Complete Saucerization or Punch Removal With Negative Margins

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• This is a retrospective cohort study of patients in the Veteran Affairs (VA) system in whom smaller (median size, 6 mm) basal cell carcinomas (BCCs) were biopsied with the intent of complete removal via either saucerization or punch biopsy technique. Subtypes included nodular (68%) and superficial/early nodular (23%). Among tumors with clear histologic margins on standard "bread loaf" sectioning, the overall recurrence rate was 3% (14/413) with a mean follow-up of 51.4 months. The recurrence rate was higher for those BCCs on the head and neck than on the trunk and extremities (6.2% vs 1.9%; P = .02), but no other clinical or histopathologic features impacted the recurrence rate significantly. Recurrent tumors were then treated with either Mohs micrographic surgery or excision.

• These findings suggest a low recurrence rate of small, low-risk BCCs with clear histologic margins in the planes of section examined when biopsied with an intent to completely excise. These findings may be difficult to generalize to a diverse patient population outside the VA system, and, with a mean follow-up of less than 5 years, further studies investigating treatment-related morbidity and a cost analysis of clinical observation are warranted.

– Margaret Hammond, MD

Abstract 

Clinically well-defined, smaller (<1 cm) basal cell carcinomas (BCCs) are often amenable to saucerization shave or punch biopsy with intent for complete removal at diagnosis. Few studies have assessed whether narrow-margin complete biopsy with negative histopathologic margins may be sufficient treatment for lower-risk BCCs; limited data of mainly superficial BCCs tangentially shave biopsied with negative margins showed low (0.5%) recurrence.1 Our retrospective analysis aimed to determine: 1) local recurrence of completely biopsied BCCs with negative histopathologic margins on standard vertical "breadloaf" sectioning that were then clinically observed and 2) whether pre-biopsy size, biopsy type, anatomic location, subtype, and histologic deep and peripheral margin measurement differed in recurrent vs nonrecurrent cases.

Journal of the American Academy of Dermatology

Local Recurrence of Clinically Observed Basal Cell Carcinomas Following Complete Saucerization or Punch Removal With Negative Margins: Retrospective Case Series From 2010 to 2020

J Am Acad Dermatol 2020 Mar 28;[EPub Ahead of Print], KJ Ransohoff, KM Nord, EE Bailey, JD Ransohoff, S Li, SM Swetter 

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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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