Cánceres cutáneos de estirpe no melanocítica con márgenes quirúrgicos histológicos positivos. Estudio comparativo entre los servicios implicados en su extirpación quirúrgica

Abstract

BackgroundBasal cell carcinoma and squamous cell carcinoma are the most frequent primary non-melanoma skin cancers. Surgical excision with predetermined margins is the treatment of choice in most cases. Some authors have observed positive surgical and histological margins in up to 15.7% of all excised non-melanoma skin cancers. ObjectiveTo determine the overall rate of positive surgical margins and the rate of positive surgical margins by department involved in the surgical treatment of a series of 1,104 carcinomas, and analyze their repercussions on patient care in our health area. Material and methodsRetrospective study of histopathological reports with a histopathological diagnosis of primary non-melanoma skin cancer with positive surgical and histological margins during the three-year period from 2000-2002. The following parameters were assessed in these reports: the departments that took part in the surgical treatment, histological type and subtype of carcinoma, surgical boundary invaded by the neoplasm, specifying whether it is the lateral or deep boundary, or both, and anatomic location of the carcinoma. ResultsIn Dermatology, 770 carcinomas were excised, 60 (7.7 %) of which had positive margins; in General Surgery, 304 carcinomas were excised, 92 of which (30.2%) showed positive margins; and in Primary Care, 18 carcinomas were excised, 8 (44.4 %) of which had positive margins. Basal cell carcinomas were the carcinomas that most often had positive margins (70 %). The most commonly invaded surgical margin was the lateral one (76.2 %), and the most frequent location the face (58 %). ConclusionThe rate of carcinomas with positive surgical and histological margins in the Dermatology Department is lower than the rate described by other authors, and much lower than the ones observed in the non-dermatological departments in our health area (General Surgery and Primary Care). The need for further surgery in a large number of these carcinomas with positive margins once again adds the patients to the already long surgical waiting list for these skin lesions in our health area, and increases the delay in their definitive treatment.