Ten years' experience in the surgical treatment of basal-cell carcinoma. A study of factors associated with recurrence

Abstract

A retrospective review of 817 basal‐cell carcinomas Which were treated surgically and confirmed by histological examination is presented. Slightly more than half of the 590 patients were men. Eighty per cent of the lesions occurred in patients over the age of 50 years. Ninety‐four per cent of the lesions occurred in the head and neck with the highest density in the nasal and periorbital regions. One lesion in 4 had been unsuccessfully irradiated prior to referral. Less than one‐half of the pathology reports gave any indication of completeness of removal. Nineteen per cent of these reported tumour in the margin of resection, indicating incomplete removal. Over half of the lesions were kept under observation for more than 2 years. The overall recurrence rate for the series was 9.8 per cent, but for the 535 lesions treated primarily by us the recurrence rate was 5.2 per cent. Factors producing an increased risk of recurrence probably operate in combination making it difficult to evaluate them individually. Such factors are: (a) the anatomical site, the nasal and periorbital regions carrying the highest risk; (b) previous treatment before referral, including irradiation; (c) free skingrafting as a method of repairing the defect; (d) the presence of tumour histologically in the margin of resection. Fifty‐nine lesions did not recur in spite of pathology reports which indicated incomplete removal. This was not related to either a shorter length of follow‐up or the type of repair used in these cases.