“EFFICACY OF 3MM CLINICALLY PALAPABLE EXCISION MARGINS FOR THE TREATMENT OF 2CM OR LESS PRIMARY FACIAL BCCS”

ABSTRACT
Objectives: To determine the efficacy of 3mm clinically palpable excision margins for the treatment of 2cm or less
primary facial Basal cell carcinoma (BCC) in terms of margin clearance and recurrence.
Study design: Descriptive cross-sectional
Place and Duration: Plastic Surgery Clinic, Aman Hospital Dabgari Gardens Peshawar from January 2012 to Jan 2014.
Material and Methods: A total of 40 clinically diagnosed primary facial BCCs, were included in the study. Tumor size
more than 2cm, recurrent tumors, patients who received preoperative radiotherapy were excluded from the study. They
were excised taking 3mm clinically palpable excision margins by the same Plastic surgeon and tissue specimens sent
to same laboratory for histopathological confirmation and margin clearance. These patients were analyzed in terms of
margin clearance and recurrence rate. All patients were followed for a minimum of two years to see for any recurrence.
Results: A total of 40 patients each with a single tumor including 32 male and 8 female with a mean age of 58.6 years
were studied. 36(90%) tumors were histologically clear of tumor cells while in 4(10%) cases, tumor was found involved.
Out of these 4 patients, 3(7.5%) patients had their tumor involved on lateral sides while deep involvement was found in
1(2.5%) patient. Periocular area was found to be the most common site for incomplete excisions i.e. 3(7.5%) followed
by nose in 1(2.5%) patient. During 2 years follow-up period, only 1 (2.5%) patient had tumor recurrence.
Conclusion: As there is strong interplay between achieving clear excision margins and obtaining satisfactory cosmetic
and functional outcome, therefore keeping margin clearance to minimum can solve this dilemma. Moh’s micrographic
surgery, though addresses these issues, but due to its non availability in Pakistan, is not practicable.
Therefore we propose that clinical excision margins of 3mm might be adequate for tumors of 2cm or less. Further
randomized controlled trials will have to be carried out to strengthen this hypothesis.
Key words: Basal cell carcinoma; excision; margin clearance, rec