Margin status of basal cell carcinoma: What can be done better?

Abstract

PurposeGuidelines on clinical margins for basal cell carcinoma (BCC) excisions were recently published, yet ambiguity remains for surgeons and pathologists. The purpose of this study was to determine the incomplete excision rate of BCC, determine factors associated with incomplete excision, and evaluate completeness of reporting between surgeon and pathologist. MethodsA single-centre retrospective analysis was conducted on pathology reports from single excisions of BCC specimens, between January 1, 2019, to December 31, 2020. The primary outcome was incomplete excision rate (positive margins) as reported by pathologist. Logistic regression was used to determine the relationship between incomplete excision rate and anatomical location, pathologist, and surgeon. Completeness of surgeon pathology requisition forms was evaluated qualitatively. ResultsSeven-hundred-and-fifty-six pathology reports were included. The incomplete excision rate was 12% (n=94). The most common site of incomplete excision was head and neck (n=87, 15%), followed by trunk (n=5, 7%), and extremities (n=2, 2%). Five-hundred-and-seventy-nine specimens from 6 surgeons and 9 pathologists were included in the logistic regression analysis. Wald test showed location was significantly associated with incomplete excision (p<0.05), whereas surgeon and pathologist reports were not (p>0.05). Regarding missing information, only 47 (6%) pathology reports included “excision” in the requisition. Four-hundred-and-three (53%) specimens had no clinical history. ConclusionsThe incomplete excision rate found in this study falls within the report range in the literature. Neither surgeon nor pathologist had significant association with incomplete excision. Incomplete excision rate of BCC may be inflated due to lack of standardization in requisition form reporting and pathology reporting.