Abstract
Background: Surgical excision is the treatment of choice for basal cell carcinoma. Complete removal is the key to cure.Objective: To determine the utility of intraoperative frozen section in basal cell carcinoma surgery of high risk cases on the head and neck to achieve margin clearance.Study Design: Prospective descriptive study Place and duration of study: MH Rawalpindi, Army Medical College – February 2015 – May 2018.Methodology: All patients of high risk basal cell carcinoma, on the head and neck, undergoing excision and repair after intraoperative frozen section were included in the study. In addition to demographic profile of the patient, site and clinical type of the lesions were recorded. Histopathology report indicating margin clearance was noted.Results: A total of 96 patients with basal cell carcinoma were operated upon with intraoperative frozen section. Five patients had recurrent basal cell carcinoma whereas 91 had primary lesions. Fifty four (56.3%) patients showed all margins clear of tumor on frozen section whereas 42 (43.8%) patients required further excision of one or more margins based on the result of frozen section.Conclusion: Intra operative frozen section helped conserve skin in addition to saving 42 (43.8%) patients from a second surgical procedure.
Highlights
Basal cell carcinoma is the most common human cancer being almost as common as all other human cancers combined [1,2,3,4]
Fifty four (56.3%) patients showed all margins clear of tumor on frozen section whereas 42 (43.8%) patients required further excision of one or more margins based on the result of frozen section
High risk bccs include those with histologically aggressive subtypes, tumors with perineural invasion, tumors located in anatomically sensitive sites, recurrent tumor, tumors larger than 2 cm in size, tumors with lymph node involvement and metastasis, and those associated with immunosuppression [1,5]
Summary
Basal cell carcinoma (bcc) is the most common human cancer being almost as common as all other human cancers combined [1,2,3,4]. A recent meta-analysis, when comparing treatment modalities, confirmed that surgery is superior to cryotherapy, radiotherapy, photodynamic therapy, topical 5 flourouracil and imiquimod in terms of complete lesion clearance and least recurrence rate [8]. Surgical techniques such as Mohs Micrographic Surgery (mms) and frozen section maybe used to reduce the risk of recurrence.
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