2-mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas.
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
19
09
2019
accepted:
17
12
2019
pubmed:
19
1
2020
medline:
15
5
2021
entrez:
19
1
2020
Statut:
ppublish
Résumé
Surgery is the gold standard for basal cell carcinomas (BCC). Current recommended surgical margins for BCCs are determined from studies in Caucasian populations. However, the appropriate surgical margins for BCCs in non-white races are unclear. To investigate the accuracy of preoperative determination of clinical tumour borders and appropriate surgical margins in Japanese patients with BCC. The maximum calculated differences in distance between the preoperatively determined surgical margins and the actual histologic tumour side margins were considered as 'accuracy gaps' of clinical tumour borders. Estimated side margin positivity rates (ESMPRs) with narrower (2 and 3 mm) surgical margins were calculated on the basis of the accuracy gaps. Overall, 1000 surgically excised BCCs from 980 Japanese patients were included. The most frequent histologic subtype was nodular BCC (67%). The median accuracy gap was 0.3 mm [interquartile range (IQR): -0.5 to +1 mm]. The ESMPRs with 2- and 3-mm surgical margins were 3.8% and 1.4%, respectively. Only the ESMPRs between the well-defined (n = 921) and poorly defined clinical tumour border groups (n = 79) showed statistical difference [2-mm margin: 3.1% vs. 11.7%, OR: 3.89, 95% confidential interval (CI): 1.41-10.71, P <0.01; 3-mm margin: 0.97% vs. 6.3%, OR: 6.58, 95% CI: 1.67-25.99, P <0.01]. No significant differences in ESMPRs were noted in other subgroups including risk classifications. The determined clinical tumour border accuracy gaps in this Japanese cohort were negligible. Dermatologic surgeons may use narrower surgical margins with acceptable margin positivity rates. The clarity of clinical tumour borders could be an appropriate guide for selection of different surgical margins in the Japanese cohort.
Sections du résumé
BACKGROUND
BACKGROUND
Surgery is the gold standard for basal cell carcinomas (BCC). Current recommended surgical margins for BCCs are determined from studies in Caucasian populations. However, the appropriate surgical margins for BCCs in non-white races are unclear.
OBJECTIVES
OBJECTIVE
To investigate the accuracy of preoperative determination of clinical tumour borders and appropriate surgical margins in Japanese patients with BCC.
METHODS
METHODS
The maximum calculated differences in distance between the preoperatively determined surgical margins and the actual histologic tumour side margins were considered as 'accuracy gaps' of clinical tumour borders. Estimated side margin positivity rates (ESMPRs) with narrower (2 and 3 mm) surgical margins were calculated on the basis of the accuracy gaps.
RESULTS
RESULTS
Overall, 1000 surgically excised BCCs from 980 Japanese patients were included. The most frequent histologic subtype was nodular BCC (67%). The median accuracy gap was 0.3 mm [interquartile range (IQR): -0.5 to +1 mm]. The ESMPRs with 2- and 3-mm surgical margins were 3.8% and 1.4%, respectively. Only the ESMPRs between the well-defined (n = 921) and poorly defined clinical tumour border groups (n = 79) showed statistical difference [2-mm margin: 3.1% vs. 11.7%, OR: 3.89, 95% confidential interval (CI): 1.41-10.71, P <0.01; 3-mm margin: 0.97% vs. 6.3%, OR: 6.58, 95% CI: 1.67-25.99, P <0.01]. No significant differences in ESMPRs were noted in other subgroups including risk classifications.
CONCLUSIONS
CONCLUSIONS
The determined clinical tumour border accuracy gaps in this Japanese cohort were negligible. Dermatologic surgeons may use narrower surgical margins with acceptable margin positivity rates. The clarity of clinical tumour borders could be an appropriate guide for selection of different surgical margins in the Japanese cohort.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1991-1998Subventions
Organisme : National Cancer Center Research and Development Fund
ID : 29-A-3
Informations de copyright
© 2020 European Academy of Dermatology and Venereology.
Références
Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med 2005; 353(21): 2262-2269.
Mendez BM, Thornton JF. Current basal and squamous cell skin cancer management. Plast Reconstr Surg 2018; 142(3): 373e-387e.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Basal Cell Skin Cancer Version1.2019-August 31 2018, https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf. In. 2019.
Ito T, Inatomi Y, Nagae K et al. Narrow-margin excision is a safe, reliable treatment for well-defined, primary pigmented basal cell carcinoma: an analysis of 288 lesions in Japan. J Eur Acad Dermatol Venereol 2015; 29(9): 1828-1831.
Cho S, Kim MH, Whang KK et al. Clinical and histopathological characteristics of basal cell carcinoma in Korean patients. J Dermatol 1999; 26(8): 494-501.
Takenouchi T, Takatsuka S. Long-term prognosis after surgical excision of basal cell carcinoma: a single institutional study in Japan. J Dermatol 2013; 40(9): 696-699.
Lin SH, Cheng YW, Yang YC et al. Treatment of pigmented basal cell carcinoma with 3 mm surgical margin in Asians. Biomed Res Int 2016; 2016: 1-6.
Japanese Dermatological Association Guidelines: guidelines for practice of skin cancer, 2015 https://www.dermatol.or.jp/uploads/uploads/files/guideline/guideline_SknCncr.pdf (Japanese)
Sexton M, Jones DB, Maloney ME. Histologic pattern analysis of basal cell carcinoma. Study of a series of 1039 consecutive neoplasms. J Am Acad Dermatol 1990; 23(6 Pt 1): 1118-1126.
Dauendorffer JN, Bastuji-Garin S, Guero S et al. Shrinkage of skin excision specimens: formalin fixation is not the culprit. Br J Dermatol 2009; 160(4): 810-814.
Blasco-Morente G, Garrido-Colmenero C, Perez-Lopez I et al. Study of shrinkage of cutaneous surgical specimens. J Cutan Pathol 2015; 42(4): 253-257.
Ramdas K, van Lee C, Beck S et al. Differences in rate of complete excision of basal cell carcinoma by dermatologists, plastic surgeons and general practitioners: a large cross-sectional study. Dermatology 2018; 234(3-4): 86-91.
Wolf DJ, Zitelli JA. Surgical margins for basal cell carcinoma. Arch Dermatol 1987; 123(3): 340-344.
Kimyai-Asadi A, Alam M, Goldberg LH et al. Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas. J Am Acad Dermatol 2005; 53(3): 464-468.
Breuninger H, Dietz K. Prediction of subclinical tumor infiltration in basal cell carcinoma. J Dermatol Surg Oncol 1991; 17(7): 574-578.
Nakamura Y, Tanese K, Hirai I et al. Evaluation of the appropriate surgical margin for pigmented basal cell carcinoma according to the risk factors for recurrence: a single-institute retrospective study in Japan. J Eur Acad Dermatol Venereol 2018; 32(12): e453-e455.
Takenouchi T, Nomoto S, Ito M. Factors influencing the linear depth of invasion of primary basal cell carcinoma. Dermatol Surg 2001; 27(4): 393-396.
Armstrong LTD, Magnusson MR, Guppy MPB. Risk factors for recurrence of facial basal cell carcinoma after surgical excision: a follow-up analysis. J Plast Reconstr Aesthet Surg 2017; 70(12): 1738-1745.