Most Patients With Head and Neck Basal Cell Carcinomas With Closely Excised Margins Require Further Surgery of Follow-Up: Presented at AAO-HNSF

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Title: Most Patients With Head and Neck Basal Cell Carcinomas With Closely Excised Margins Require Further Surgery of Follow-Up: Presented at AAO-HNSF
URL: http://www.pslgroup.com/dg/22D762.htm
Doctor's Guide
September 24, 2008

By Mary Beth Nierengarten

CHICAGO -- September 24, 2008 -- Most patients who undergo complete excision for head and neck skin cancer, including those with close surgical margins, do not require further surgery or follow-up, according to research presented here at the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO.

Close-margin -- but complete -- excisions of head and neck basal cell carcinomas (BCCs) rarely indicate a need for further follow-up of the patient, according to researchers led by Martyn L. Barnes, MBBS, Asthma and Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital and Perth Royal Infirmary, University of Dundee, Dundee, Scotland, United Kingdom.

Although the data were similar for patients with squamous cell carcinomas (SCC), there were too few patients in the study to draw the same conclusion for this particular population, Dr. Barnes said.

In addition, he emphasised that certain groups at high risk of recurrence, including patients who are immunosuppressed or those with Gorlin's syndrome, should be followed.

These conclusions were drawn from a study that Dr. Barnes and colleagues conducted to determine the clinical and histological outcomes for patients after close margin excisions of head and neck skin cancer, which he presented on September 23.

The investigators conducted a retrospective review of all skin excisions performed in their otolaryngology department from 1991 to 2008 using pathology reports and case notes to identify patients with closely excised lesions.

Of the 1,223 cases of skin cancer they examined, histological data was obtained on 1,207 cases; 76% of patients had basal cell carcinoma and 24% had squamous cell carcinoma.

Of 1,060 histological records available on margins, complete excision was achieved in 72.4% of patients; 16.1% had close (<1 mm) margins and 11.5% had incomplete excisions.

From these data, the investigators identified 112 patients with closely excised lesions and were able to obtain case notes on 107 of these patients. Of the 107 patients, 2 underwent further excision immediately.

Examination of the remaining 105 patients with closely excised lesions showed a clinically-suspicious recurrence in 8 patients (of which 5 were shown not to be a recurrence on histology); 10 patients during follow-up were diagnosed with new lesions, 1 of which was malignant. After follow-up, 12 patients developed new lesions, 6 of which were malignant.

Overall, no further excision was required in 104 (97%) of the original closely-excised lesions during the 4.1 years following the initial excision.

Based on these data, Dr. Barnes said that "you do not need to follow up routine patients following head and neck BCC excisions, providing [the excisions] are complete, regardless of the margin."

[Presentation title: Close Margin Excision Outcomes in Head and Neck Skin Cancer. Abstract S108]

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