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Review
. 2020 Jul 15;12(7):e9211.
doi: 10.7759/cureus.9211.

Surgical Margin of Excision in Basal Cell Carcinoma: A Systematic Review of Literature

Sohail J Quazi  1   2 , Nida Aslam  3 , Hajra Saleem  4 , Jawaria Rahman  5 , Safeera Khan  6
Affiliations
Review

Surgical Margin of Excision in Basal Cell Carcinoma: A Systematic Review of Literature

Sohail J Quazi et al. Cureus. .

Abstract

Skin cancer is one of the most common cancers in the world and consists of melanoma and non-melanoma skin cancer (NMSC). Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common non-melanoma skin cancers. The ideal surgical treatment for BCC is complete removal, and it can be achieved either with safety margins or with micrographic control. The currently accepted treatment for basal cell carcinoma is an elliptical excision with a 4-mm surgical margin of clinically normal skin. However, because of cosmetic and functional constraints on the face, a 4-mm surgical margin is often not feasible. We used PubMed, PubMed Central (PMC), and Google scholar as our main databases to search for the relevant published studies and used "Basal cell carcinoma" and "narrow excision margins" as Medical Subject Headings (MeSH) keywords. Fifteen studies were finalized for the review, which included 3843 lesions. The size of the lesions ranged from 3 to 30 mm, with a mean size of 11.7 mm. Surgical margins varied from 1 to 5 mm. This review was done to evaluate if small, well-defined primary BCCs can be excised using narrow surgical margins. Based on the reviewed literature, we found that for primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm gives satisfactory results. In the high-risk group, and for lesions larger than 2 cm, a 4-6 mm margin is suggested for getting clear margins. Mohs micrographic surgery is advocated for more complex and recurrent lesions where the clinical margin is not apparent. However, micrographic surgery is not readily available in many places and requires more training and experience. Therefore, excision with 2 mm margins for clinically well-defined lesions with close follow-up can be followed to preserve the healthy tissue in anatomic constraint lesions and avoid the need for complex reconstructive procedures.

Keywords: basal cell carcinoma; narrow excision margin; non-melanoma skin cancer.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA diagram
Figure 2
Figure 2. Algorithm for surgical margins in different types of BCC
See this image and copyright information in PMC

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