Facial Basal Cell Carcinoma Research Articles

Cost Analysis of Mohs Micrographic Surgery in High-Risk Facial Basal Cell Carcinoma

Introduction Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost. Objectives To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS. Material and methods Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence. Results Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was €106 129.07 and €1325.80, respectively (compared to €97700 and €1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant ( P=.534). Conclusions MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

LETTERS TO THE EDITOR

Dear Editor, Vulval location: An indication for staging in basal cell carcinoma? Recently, DeAmbrosis et al. reported in the journal a case series of four vulval basal cell carcinoma (BCC). All the tumours were primary, and the maximum tumour size was 15 mm. The histopathological exam did not report invasion of deep structures, and none of the patients had previous history of radiation therapy. No clinical evidence of lymphadenopathy was reported at time of presentation. All patients underwent computed tomography (CT) of the abdomen and pelvis as a component of screening prior to surgery.1 The authors make several assertions that we disagree with. In the discussion, the authors recommend the use of this technique, as ‘CT scanning improves diagnosis accuracy’.1 In their opinion, ‘the risk of missing malignant inguinal lymphadenopathy is greater than the very marginal risk of the radiation from the CT scan’.1 We believe that in medical practice, before carrying out a particular technique, a careful benefit/risk analysis should be performed. A clear example is cutaneous malignant melanoma. Despite the marginal risk of the radiation from the CT scan, asymptomatic stage I melanoma patients should not be staged by imaging, as the true-positive pick-up rate is low and the false-positive rate is high.2 In other words, the benefit/risk relationship is unfavourable because the risk is low but the benefit is even lower. Although BCC is the most common skin cancer, metastatic BCC (MBCC) is rare, with an incidence of 0.0028–0.1%.1 Risk factors that should lead to a higher index of suspicion among clinicians for identifying MBCC include large tumour size, significant tumour depth, previous irradiation, recurrence, immunocompromised patients, and primary BCC of the head and neck.3, 4 Even though higher rates of metastasis occur from primary lesions on the face, scalp and genitalia, MBCC arising from a primary tumour less than 2 cm in diameter is extremely infrequent.4 Risk of metastasis has been further shown to specifically correlate with the size of the primary tumour: tumours greater than 3 cm conferring 2% risk, greater than 5 cm conferring 25% risk, and greater than 10 cm conferring 50% risk.3 Except for their location, none of the cases of DeAmbrosis et al. exhibit any of the recognizable risk factors for MBCC (with the exception of case 1, which presents squamous differentiation). Although we agree that vulval location is a risk factor for MBCC, we feel that CT scanning should not be performed in all cases of vulval BCC, as it should not be performed in all cases of facial BCC (albeit two-thirds of MBCC arise from primary tumours on the face4). We believe that ‘the very marginal risk of the radiation from the CT scan’ does not justify the routine staging use of this technique in asymptomatic patients unless it is supported by the presence of the risk factors recognized in the medical literature.

What Lies Beneath? A Lesson for the Clinician. Intraoperative Frozen Section Appearance of Persistent Basal Cell Carcinoma after Apparent Cure with Imiquimod 5% Cream

The Food and Drug Administration (FDA) has approved imiquimod 5% cream for the treatment of nonfacial superficial basal cell carcinoma (BCC), and it has increased in popularity as a nonsurgical approach for the treatment of BCC. Its use for the treatment of superficial BCCs on the trunk, neck, and extremities has been documented in the dermatology and family physician literature. Studies of imiquimod for nodular BCC, on the other hand, have demonstrated suboptimal cure rates according to both clinical and histologic criteria, but little is known about the efficacy of imiquimod cream in the treatment of more extensive lesions, more aggressive BCC subtypes, or treatment in higher risk locations like the face, although the off-label practice of treating facial BCCs with imiquimod is not rare.

Addiction to Tanning - A New Cause of Early Onset of Nonmelanoma Skin Cancer

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer world wide. UV exposure plays a significant role in the pathogenesis of this tumor that is more common in older people. In the past, BCC in people younger than 30 years of age have been seen in connection with genetic diseases like Gorlin-Goltz syndrome. The histological type was mostly superficial and most common localization was on the trunk. Nowadays, frequent indoor tanning is a risk behavior that might lead to early development of facial and aggressive BCC in people younger than 30 years of age. This is illustrated by a case report of a 29-year old addictive indoor tanner, skin type I, who developed a solid BCC of the nose after more than 10 years of weekly tanning. Current health campaigns and preventive programs seem to be ineffective in this subgroup of patients. New strategies need to be developed.

Measurements of the anatomical distribution of erythemal ultraviolet: a study comparing exposure distribution to the site incidence of solar keratoses, basal cell carcinoma and squamous cell carcinoma

Measurements of anatomical UV exposure distribution were made using miniaturized polysulfone dosimeters over a four year period between 2005 and 2008 in Toowoomba, Australia (28 degrees S, 152 degrees E). Anatomical UV exposures were expressed relative to the horizontal plane ambient UV. The UV exposures were compared with existing data detailing the anatomical distribution of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and solar keratoses (SK). Surface UV exposures to unprotected skin surfaces have been presented for each of the face, neck, arm, hand and leg assessing a total of 1453 body sites (2491 measurements). Measured exposures are presented for the human facial region to a resolution of 5 mm. The median anatomical UV expressed relative to the horizontal plane ambient UV for each of the face, neck, forearm, hand and leg regions of the body varied from 26%, 23%, 13%, 30% and 12% respectively in the 0 degrees-30 degrees SZA range; 39%, 36%, 17%, 35% and 23% in the 30 degrees-50 degrees SZA range; and 48%, 59%, 41%, 42% and 47% in the 50 degrees-80 degrees SZA range. Detailed positions of UV exposure measured over the face, neck, arm, hand and leg were more closely related to NMSC incidence data for the face and upper limbs. Further analysis with existing facial BCC and SK density data did not however show a direct relationship with the measured UV exposures highlighting the importance of other factors influencing the causation and localisation of facial NMSC.

Bilateral Hand Transplantation: Result at 20 Months

On November 2006, a bilateral hand allotransplantation was performed for a 47-year-old female who had suffered radiocarpal amputations 28 years before. Technical aspects of the operation are detailed. Alemtuzumab induction, and triple therapy of tacrolimus, mycophenolate mofetil and prednisone were used to control rejection. The evolution of the result and functioning at 20 months are presented in detail. Two acute rejection episodes occurred and were successfully treated with steroids. In addition the patient developed a factitious visual disorder and a facial basal cell carcinoma. Functionally, at 20 months, the patient had a Hand Registry Functional Score of 69 (good), and a DASH score of 19.

Síndrome de Gorlin (Síndrome Nevoide Basocelular)

A 77 year-old male patient with Parkinson's disease and senile dementia had many facial basal cell carcinomas and an ectropion of the left eye. When he experienced respiratory difficulty he was diagnosed to have an ameloblastoma in left nostril requiring surgery. Gorlin syndrome is an autosomal dominant condition characterized by basal cell carcinomas, and skeletal and neurological anomalies. The presence of multiple basal cell carcinomas on the eyelids in a child or in a young patient should alert ophthalmologists to the possibility of this syndrome.

Cost Comparisons of Managing Complex Facial Basal Cell Carcinoma: Canadian Study

Basal cell carcinoma (BCC) is the most common human malignancy and accounts for over 60,000 new cases of cancer in Canada annually. Although expensive to the health care system, no Canadian studies have reported the costs involved in management. This study calculated the costs of managing high-risk BCCs using radiotherapy (RT) and Mohs micrographic surgery (MMS). Forty-nine consecutive complex BCC cases presenting to a skin cancer referral center were collected prospectively. All were located on the head and neck and were either recurrent disease or located in "at risk" sites such as the eye, ear, lip, or nose. All patients underwent MMS. A radiation oncologist reviewed each case retrospectively. The costs of MMS were the actual costs of the procedure, with an additional amount added to account for the technical costs of the surgery. The costs of RT included physician fees and technical fees. A sensitivity analysis was performed using known recurrence rates from the medical literature. Five patients were excluded from the comparative analysis because radiation was not recommended (age < 50 years or radiation would overlap with a previous radiation field). The direct cost of treating a patient with a single BCC was $871 (range $630-1,159) using MMS and $3,625 (range $3,430-3,971) using RT. The costs were significantly higher for patients with multiple tumors with both modalities (p = .02 for both). The direct costs of a "5-year cure" were $952 (range $644-1,647) for MMS and $3,758 (range $3,564-4,675) for RT. This study attempted to document the costs associated with two well-recognized and effective methods of treating complex BCC in Ontario. Subgroup analysis revealed independent associations between aggressive histology, larger size, and complexity of surgical closure with higher costs. Although we did notice a trend toward greater costs in patients with recurrent disease, in males, younger patients, and tumors present for > 1 year, these did not reach significance within our sample size. Despite the limitation that treatment costs may be center and provincially dependent, we hope this preliminary report will initiate further study into comparing Canadian costs of managing skin cancer.

Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology

The aim of this study was to analyze the scope of pre-surgical high resolution ultrasound in basal cell carcinoma (BCC). BCC is the most common human cancer. According to recent large prospective studies incomplete excision of BCC is higher than expected. Pre-operative imaging may aid surgical planning by identifying the extent and location of a neoplasm, which can be interesting at zones with higher risk of recurrences such as the face. These are slow growing tumors but there are some aggressive types described that can involve deeper structures. Twenty-five patients were studied (10 F/15 M, 48–91 years old; mean age 69.5 ± 11.5 years) with suspicious facial lesions ≤1.5 cm. Pre-surgical ultrasound with compact linear 15–7 MHz probe was performed. Ultrasound reported the morphology and thickness of the tumors. The results were correlated with the histology. Ultrasound identified 29 suspicious facial lesions that were removed with tumor-free borders at the first surgery and confirmed by histology. The main location was the nose. Two subclinical satellite lesions at the nasal zone were detected under ultrasound which led to a change in the surgery plan. The intraclass correlation coefficient (ICC) value was used to compare tumor thickness measurements between ultrasound and histology. ICC was considered as very good (0.9). Therefore, ultrasound can be useful to plan BCC surgery, it can recognize lesions, layers of involvement and vascularity patterns in a non-invasive way. It can show subclinical satellite lesions, even though the number of subclinical cases is small and require further investigations. It has a good thickness correlation with histology and may be used as a technique to monitor disease changes following non-invasive medical treatments in the future.

Photodetection of basal cell carcinoma using methyl 5-aminolaevulinate-induced protoporphyrin IX based on fluorescence image analysis

The preferential accumulation of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) in neoplastic cells supports its potential use in the photodetection of porphyrin fluorescence in tumour cells. Hence, epithelial tumours, including basal cell carcinoma (BCC), might be visualized using the fluorescence of selectively accumulated ALA-induced PpIX. In this study, we evaluated the clinical efficacy of PpIX fluorescence images using fluorescence image analysis (FIA) to define the lateral border between the tumour and tumour-free areas of facial BCC. FIA was used to define the lateral border between the tumour and tumour-free areas on red fluorescence images induced by the topical application of methyl 5-aminolaevulinate (MAL) ointment. According to the FIA results, 50 tissue samples, obtained from 10 patients with BCC, were divided into three categories: tumour area (n = 10), suspected tumour area (n = 20) and suspected tumour-free area (n = 20). These tissue samples were evaluated by histopathological examination. The FIA tool marked out the PpIX fluorescence image for defining the lateral border between the BCC tumour and tumour-free areas. The rate of tumour detection from BCC lesions using PpIX fluorescence with the FIA tool showed a sensitivity of 94.1% and specificity of 82.6%. These results suggest that MAL-induced PpIX fluorescence imaging using FIA is quite sensitive and specific for detecting tumour and occult tumour in facial BCC lesions. This method of presurgical in vivo imaging is therefore proposed as a useful tool for defining the lateral border between BCC tumour and tumour-free areas.

Interventions for basal cell carcinoma of the skin

Basal cell carcinoma (BCC) is the commonest skin cancer. BCCs are slow-growing, locally invasive, epidermal skin tumours which mainly affect white skinned people. The first line treatment is usually surgical excision, but numerous alternatives are available. To assess the effects of treatments for basal cell carcinoma. We searched the Cochrane Skin Group Specialised Register (January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane LIbrary Issue 1, 2006), the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 1, 2006), MEDLINE (2004 to January 2006), EMBASE (2005 to January 2006), the metaRegister of Controlled Trials (February 2006). Cited references of all trials identified and key review articles were searched. Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials. Inclusion criteria were adults with one or more histologically proven, primary basal cell carcinoma. The primary outcome measure was recurrence at three to five years, measured clinically. The secondary outcome included early treatment failure within six months, measured histologically. Adverse treatment effects included aesthetic appearance and pain during and after treatment. Two authors independantly carried out study selection and assessment of methodological quality. Twenty seven studies were identified. Only one RCT of surgery versus radiotherapy had primary outcome data at four years, showing significantly more persistent tumours and recurrences in the radiotherapy group as compared to the surgery group, (RR 0.09, 95%CI, 0.01 to 0.69). One study found no significant difference for recurrence at 30 months when Moh's micrographic surgery was compared to surgery for high risk facial BCCs, (RR 0.64, 95%CI 0.16,2.64). One study of methylaminolevulinate photodynamic therapy (MAL PDT) versus cryotherapy found no significant difference in recurrences in the MAL PDT group when compared to cryotherapy at one year (RR 0.50, 95% CI 0.22,1.12). Cryotherapy showed no significant difference in recurrences at one year when compared to surgery on one small study. When radiotherapy was compared to cryotherapy there were significantly fewer recurrences at one year in the radiotherapy group compared to the cryotherapy group.Short-term studies suggest a success rate of 87 to 88% for imiquimod in the treatment of superficial BCC using a once-daily regimen for 6 weeks and a 76% treatment response when treating nodular BCC for 12 weeks, when measured histologically. Overall there has been very little good quality research on treatments for BCC. Most trials have only evaluated BCCs in low risk locations. Surgery and radiotherapy appear to be the most effective treatments with surgery showing the lowest failure rates. Although cosmetic outcomes appear good with PDT, long term follow up data are needed. Other treatments might have some use but few have been compared to surgery. An ongoing study comparing imiquimod to surgery should clarify whether imiquimod is a useful option.

Use of 5% imiquimod cream in the treatment of facial basal cell carcinoma: A 3‐year retrospective follow‐up study

There has been considerable research into the safety and efficacy of topical 5% imiquimod cream for the treatment of skin cancers in recent years, in particular superficial and nodular basal cell carcinomas. However, there are limited long-term follow-up studies. This retrospective study aims to determine the efficacy of 5% imiquimod cream in the treatment of facial basal cell carcinomas over 3 years. Medical records of 12 patients treated with 5% imiquimod cream at a private dermatology practice during 2001 and 2002 were retrospectively reviewed. Target tumours included superficial and nodular basal cell carcinomas, giving a total lesion number of 19. Patients were commenced on a once daily treatment regimen for up to 9 weeks, and given rest periods as required according to the severity of application site reactions. We found that 5% imiquimod cream is an effective treatment option for superficial and nodular basal cell carcinomas, giving a clearance rate of 89.5% at an average of 39 months of follow up.

Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face

To assess the cost-effectiveness of Mohs micrographic surgery (MMS) compared with the surgical excision for both primary and recurrent basal cell carcinoma (BCC). A cost-effectiveness study performed alongside a prospective randomized clinical trial in which MMS was compared with surgical excision. The study was carried out from 1999 to 2002 at the dermatology outpatient clinic of the University Hospital Maastricht, Maastricht, The Netherlands. A total of 408 primary (374 patients) and 204 recurrent (191 patients) cases of facial BCC were included. The mean total treatment costs of MMS and surgical excision for both primary and recurrent BCC and the incremental cost-effectiveness ratio, calculated as the difference in costs between MMS and surgical excision divided by their difference in effectiveness. The resulting ratio is defined as the incremental costs of MMS compared with surgical excision to prevent 1 additional recurrence. Compared with surgical excision, the total treatment costs of MMS are significantly higher (cost difference: primary BCC, 254 euros; 95% confidence interval, 181-324 euros; recurrent BCC, 249 euros; 95% confidence interval, 175-323 euros). For primary BCC, the incremental cost-effectiveness ratio was 29,231 euros, while the ratio for recurrent BCC amounted to 8094 euros. The acceptability curves showed that for these ratios, the probability of MMS being more cost-effective than surgical excision never reached 50%. At present, it does not seem cost-effective to introduce MMS on a large scale for both primary and recurrent BCC. However, because a 5-year period is normally required to determine definite recurrence rates, it is possible that MMS may become a cost-effective treatment for recurrent BCC.

Efficacy of Narrow-Margin Excision of Well-Demarcated Primary Facial Basal Cell Carcinomas

Efficacy of Narrow-Margin Excision of Well-Demarcated Primary Facial Basal Cell Carcinomas

Basal-cell carcinoma of face, with remote metastases and pathological fractures

Basal-cell carcinoma of face, with remote metastases and pathological fractures

Accuracy of serial transverse cross-sections in detecting residual basal cell carcinoma at the surgical margins of an elliptical excision specimen

There has been no published study estimating the proportion of positive surgical margins that is missed when serial transverse cross-sectioning (bread-loafing) is used to histologically evaluate the surgical margins. Our purpose was to estimate the accuracy of serial transverse cross-sectioning (bread-loafing) at 4-mm intervals in detecting the presence of residual tumor at the margins of well-defined facial basal cell carcinomas excised as an ellipse with 2-mm surgical margins. Forty-two small (<1 cm), well-defined, primary, nonmorpheaform facial basal cell carcinomas that had been excised as an ellipse with 2-mm margins and that had positive surgical margins utilizing en-face Mohs sections were included. After longitudinal bisection of each ellipse, frozen sections were prepared encompassing the entire surgical margin. Transparencies with parallel lines spaced at 4-mm intervals were superimposed on the histologic slides with the lines perpendicular to the epidermal surface. Areas in which the lines intersected tumor at the surgical margin were noted. The percentage of tumors that would be detected by serial cross sections was calculated on the basis of the percentage of these parallel lines that intersected tumor. The 42 tumors had a total of 50 positive surgical margins. Overall, the cross-sectional lines intersected tumor 44% of the time (95% confidence interval, 37%-51%). Only 5 (10%) of the residual tumors at the surgical margins exceeded 4 mm in their longitudinal dimension. In the 9 sections containing tumor in the deep margin, tumor intersected the lines 39% of the time. Bread-loafing at 4-mm intervals of elliptical excision specimens from facial basal cell carcinomas excised with 2-mm surgical margins is only 44% sensitive in detecting residual tumor at the surgical margins. We recommend complete histologic margin control by using en face tissue orientation (Mohs technique) to identify residual tumor and reduce the risk of tumor recurrence after elliptical excision of facial basal cell carcinomas.

Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas

A 4-mm surgical margin of clinically normal skin is the current standard for elliptical excision of basal cell carcinomas (BCCs). However, a 4-mm surgical margin is often not feasible on the face because of cosmetic and functional concerns. As such, facial excisions of BCCs are typically performed with the appropriate margin determined by the surgeon based on clinical features of the tumor. We designed a study to test the efficacy of narrow-margin elliptical excisions for the treatment of small, well-demarcated facial BCCs. A total of 134 primary, small (<1 cm), well-demarcated, facial nodular BCCs were excised as an ellipse with 1-, 2-, or 3-mm margins around the visible border of the tumor. The margin used was decided by the dermatologic surgeon based on cosmetic, anatomic, and functional factors, with the goal of clearing the tumor in a single excision. Using the Mohs technique for elliptical specimens, frozen sections were prepared and examined microscopically to provide complete histologic margin control. In all, 134 facial BCCs were included in the study. On average, the tumors measured 0.6 x 0.5 cm. Of these, 27 (20.1%) had positive margins, requiring additional excision. Excisions with 1-, 2-, and 3-mm margins were associated with positive margins in 16%, 24%, and 13% of tumors, respectively. There was no statistically significant difference in the occurrence of positive margins based on tumor size, anatomic location, or the measured margin used. Narrow margins (1-3 mm) are inadequate for the excision of small, well-demarcated, primary nodular BCCs of the face. To avoid repetitive operations and the risk of recurrence in anatomically sensitive areas, these tumors should be treated with standard wide margins (eg, 4 mm), or have Mohs micrographic surgery for histologic margin control.

Pigmentation in basal cell carcinoma involves enhanced endothelin‐1 expression

Basal cell carcinoma (BCC) is the most prevalent malignant skin tumor. In Asian patients, marked pigmentation in BCC lesions is often observed. Recently, endothelins (ETs) have been implicated to participate in the pigmentation process of BCC. Therefore, we set out to investigate the involvement of ET in the pigmentation process of BCC and the potential regulators in the pigmentation pathway. We explored the effects of an established BCC cell line on melanocytes. The growth factor profiles of BCC culture supernatant and effects of supernatant on melanocytes were documented. Potential regulators involved in the pigmentation pathway were also studied. The immunohistochemical staining of pigmented and non-pigmented BCC specimens was performed to confirm our in vitro findings. Our results showed that BCC supernatant contained significant amount of ET-1, basic fibroblast growth factor, and nerve growth factor. Furthermore, BCC supernatant stimulated melanin formation of cultured melanocytes. Addition of ET-receptor antagonist abrogated the melanogenic effect of BCC supernatant on melanocytes. Introduction of UVB irradiation decreased the ET-1 secretion by BCC cells. Immunohistochemical staining of the pigmented facial BCC specimens showed prominent expression of ET-1 on pigmented BCC, while the non-pigmented facial BCC specimens showed little ET-1 reactivity. Tumor necrosis factor-alpha (TNF-alpha) staining showed little expression on BCC specimens, regardless of pigmentation status. In summary, our results indicate that enhanced ET-1 expression in pigmented BCC plays an important role in the hyperpigmentation of this tumor. Moreover, this enhanced ET-1 cascade showed little correlation with UV irradiation and TNF-alpha expression in our study.

An assessment of incomplete facial Basal cell carcinoma excision.

To determine the rate and cause(s) of incomplete excision of basal cell carcinoma, occurring on face. A non-interventional, descriptive study. Plastic Surgery Unit, Hayatabad Medical Complex, Peshawar, from January 2002 to March 2004. Patients with basal cell carcinoma of the face reporting to the OPD were included in the study and were booked for surgery. After excision, all tumors specimens were marked at 12 o'clock and sent to laboratory for histopathology to confirm the diagnosis and to know the completeness/incompleteness of tumor excision. If biopsy reported residual tumor in any of the margins it was noted and projected as percentage for the purpose of our results. Out of 56 patients, 49 (87.5%) had complete excision of tumor. Six (10.7%) had residual tumor while in one (1.7%) patient, biopsy report failed to mention the involvement/clearance of margins. Six patients with residual tumor were given postoperative radiotherapy. All patients were followed for a minimum of 2-1/2 years (critical period for recurrence) with careful watch on those with residual tumor. So far, only 2 of these 6 had recurrence of lesion. Both of them were greater than 2 cm in diameter and were located on medial canthal and nasolabial region. Chances of incomplete tumor excision are more on the mid face region. Patients with residual tumor are more prone to recurrence.

Determinants of satisfaction with the health state of the facial skin in patients undergoing surgery for facial basal cell carcinoma

Objective The main objective of the study was to assess which health beliefs predict and explain satisfaction with the facial health state of patients undergoing surgery for basal cell carcinoma. Methods Data were collected by administering a newly developed questionnaire pre-operatively and 6 months post-operatively ( n = 222). Results Results show that satisfaction as measured by post-operative worrying, susceptibility and fear of developing a new BCC at other facial sites can be predicted by pre-operative health beliefs. In addition, some patients an increase in perceived susceptibility, fear of recurrence of BCC on the same site or fear of developing a new BCC at other facial sites. Conclusion Our findings indicate that both pre- and post-operative perceptions predict and explain for a substantial part the extent to which patients are satisfied with their facial health state 6 months after surgery. Practice implications Administering a short questionnaire at the start of the treatment period will give physicians a better understanding of how patients experience this skin disease. It will also help them to adjust information about BCC and its consequences to the needs of the patient.