Incomplete Excision of Basal Cell Carcinoma: A Prospective Trial

Abstract

As a measure of the standard of surgical care, incomplete excision of skin malignancy is an important clinical indicator, developed by the Royal Australasian College of Surgeons and the Australian Council on Healthcare Standards. Reported rates of incomplete excision of basal cell carcinoma vary widely (5 to 25 percent) among centers worldwide. This prospective study reports on the incidence of incomplete excision at a tertiary referral public hospital and determines the factors that may influence this. From January of 2001 to December of 2002, 1214 basal cell carcinomas were excised at Peter MacCallum Cancer Centre. Data were collected prospectively and analyzed using the FileMaker Pro program and SPSS software. The overall percentage of incomplete excision was 11.2 percent for primary excisions. Risk factors for incomplete excision are the head site; morpheic, superficial, and infiltrative subtypes; lesions larger than 20 mm in diameter; the presence of multiple lesions; repair by skin graft; and recurrent and previously incompletely excised basal cell carcinomas. The type of anesthetic used did not affect outcome. There was no significant difference in the percentage of incomplete excision between consultants, registrars, and the clinical assistant, but this was probably attributable to the small number of cases performed by consultants at Peter MacCallum Cancer Centre. This is the largest prospective study of incomplete excision of basal cell carcinomas. The authors' result is within the range reported in the current literature but is higher than anticipated. Preoperative "red-flagging" of basal cell carcinomas most at risk of incomplete excision may lead to a better result.