Incomplete excision of non-melanoma skin cancer of the head and neck: can we predict failure?

Abstract

Reported incomplete excision rates vary widely. This study described a single center's treatment of basal cell carcinoma (BCC) and squamous cell carcinomas (SCC) of the head and neck and investigated possible causes of incomplete excision. All excised BCCs and SCCs in 2011 were included into the study. Patients were identified by the diagnostic (diagnosis-related group (DRG)) codes from DC44.0 to DC44.4. A total of 437 patients were treated for 516 skin lesions. Mean age was 71.4 years and the male–female ratio was 1.29. Incomplete tumor removal was found in 11 % of all cases. Four significant factors were identified to predict incomplete excision, including age >75 years (relative risk (RR) = 14.8 % (95 %-CI: 5.8–24.7 %)), BCC tumor size above 1.5 cm (RR = 17.1 % (95 %-CI: 3.7–28.7 %)), lack of sufficient excision margin in SCC (<6 mm) (RR = 17.1 % (95 %-CI: 0.1–36.9 %)) and lack of frozen sectioning in high-risk areas (RR = 16.9 % (95 %-CI: 7.5–27.2 %)). Neither gender, tumor type, histological subtype, biopsy prior to surgery, tumor location nor surgeon grade predicted incomplete excision. Head and neck BCCs, and SCCs are difficult to treat, and the need for complete tumor excision is mandatory prior to reconstruction. Our findings showed that causes of incomplete excision could be identified. With this knowledge, we are able to optimize our quality of treatment, patient satisfaction, and finally, the cost/effectiveness of our department. Level of Evidence: Level III, prognostic/risk study.