S108 – Close Margin Excision Outcomes in Head and Neck Skin Cancer

Abstract

Objectives 1) Determine clinical and histological outcomes for patients following close margin excisions of head and neck skin cancer. 2) Guide decisions regarding further intervention and follow-up. Methods Retrospective review of Otolaryngology department skin excisions from 1991 to 2008. Pathology reports and casenotes were reviewed to identify lesions excised with less than 1mm margins and determine their further management and outcome. Kaplan-Meier survival analysis was used to obtain the number needed to follow up for 2 years (NNFU) to detect a recurrence. Results Of 1223 skin cancers, 1207 histology reports were obtained-24% were squamous cell carcinomas, 76% were basal cell carcinomas. 1060 had histological (lateral and deep) margin assessments. Of these, 72.4% were complete, 16.1% close (<1mm) and 11.5% incomplete. 112 closely excised lesions were identified and 107 casenotes were obtained. 2 underwent ‘immediate’ further excision, both demonstrating no residual tumour. Of the remaining 105 subjects, 8 developed clinically suspected recurrence, but 5 were disproved histologically. During follow-up, 10 subjects had a new lesion diagnosed (9 malignant). 12 patients had new lesions diagnosed beyond follow-up; 6 were malignant. 104 (97%) of the original closely excised lesions did not require further excision within the study's 4.1 years of observation (mean) following the initial procedure (range 1.5–12.1). The NNFU following close margin excisions was 34 (95% CI 16 to infinity). Conclusions In similar cases, close surgical margins will rarely indicate a need for further surgery or follow-up. Good quality patient advice leaflets and self-monitoring is advised.