Audit of histologically incompletely excised basal cell carcinomas: recommendations for management by re-excision

In an audit of 1392 basal cell carcinomas arising in 1165 patients, excised under the care of one consultant in the 10 years from 1988 to 1997, 99 (7 %) were reported histologically as incompletely excised. Lateral margins alone were involved in 54 (55 %), deep margins in 36 (36 %) and both in 9 (9 % ). Although the policy throughout this period was to re-excise all such lesions, 74/99 (75 %) were re-excised (compared with an average re-excision rate of 30 % through other published series). For those patients undergoing re-excision, residual tumour was reported histologically in 40/74 (54 %). Peri-orbital lesions showed an overall incomplete excision rate of 13 % (range 11-17 %); however, only 4/16 of re-excisions in this area revealed residual tumour. Many clinicians have traditionally observed patients with incompletely excised basal cell carcinomas. The present study reports the largest series of re-excisions after incomplete excision of basal cell carcinoma, and has revealed that on the balance of probability such re-excisions will reveal residual tumour. Re-excision appears the appropriate course in almost all the anatomical areas studied although, with the exception of the inner canthus, periorbital lesions will have a low probability of residual tumour being identified.