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Vol. 98. Núm. 10.
Páginas 679-687 (Diciembre 2007)
Vol. 98. Núm. 10.
Páginas 679-687 (Diciembre 2007)
Controversies in dermatology
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Management of Basal Cell Carcinomas With Positive Margins
Actitud Ante Los Epiteliomas Basocelulares Con Bordes Afectos
L. Ríos-Buceta
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Correspondence: Servicio de Dermatología. Hospital Universitario Ramón y Cajal. Carretera de Colmenar Km 9,1. 28034 Madrid. Spain.
Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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A common problem in day-to-day practice is the approach to take following resection of basal cell carcinoma with positive margins. In such cases, it is important to decide whether we should take a wait-and-see approach or consider re-excision or radiotherapy. To make this decision, 4 key points need to be clarified: the significance of positive margins; whether positive margins are equivalent to tumor persistence; whether negative margins equate with complete excision; and the rate of recurrence in cases of re-excision compared with those in which a wait and see approach is taken. Having addressed each of these points, the approach will depend on the characteristics of the individual case. Based on the evidence presented, an aggressive approach involving re-excision would seem indicated in aggressive cases, whereas a flexible strategy combining observation, surgery, and radiotherapy (or other treatments) can be used in less aggressive cases.

Key words:
basal cell carcinoma

Un problema habitual en la práctica diaria es la actitud que debemos adoptar tras la resección quirúrgica de un epitelioma basocelular con afectación de alguno de los bordes. Que tipo de actitud debemos adoptar en estos casos: ¿observar?, ¿reextirpar?, ¿radiar? Para responder, en el artículo se desgranan una serie de conceptos: cuál es el significado de bordes afectos; ¿es equivalente borde afecto a persistencia tumoral?; ¿es equivalente borde libre a extirpación tumoral completa?; cuál es el porcentaje de recidivas al comparar la reextirpación y la observación.

Después de aclarar cada una de las preguntas, la respuesta sobre qué actitud tomar depende de las características de cada caso. Con las evidencias que se presentan parece indicada una actitud agresiva de reintervención en los casos graves y una estrategia flexible que combine la observación, la cirugía y la radioterapia (u otros tratamientos) en los casos menos agresivos.

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N. Smeets.
Little evidence available on treatments for basal cell carcinoma of the skin.
Cancer Treat Rev, 31 (2005), pp. 143-146
F. Bath-Hextall, J. Bong, W. Perkins, H. Williams.
Interventions for basal cell carcinoma of the skin: systematic review.
J.M. Abide, F. Nahai, R.G. Bennett.
The meaning of surgical margins.
Plast Reconstr Surg, 73 (1984), pp. 492-497
R.W. Griffiths.
Audit of histologically incompletely excised basal cell carcinomas: recommendations for management by re-excision.
Br J Plast Surg, 52 (1999), pp. 24-28
D.P. Sarma, C.C. Griffing, T.G. Weilbaecher.
Observations on the inadequately excised basal cell carcinomas.
J Surg Oncol, 25 (1984), pp. 79-80
H.C. Bieley, R.S. Kirsner, B.A. Reyes, L.D. Garland.
The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma.
J Am Acad Dermatol, 26 (1992), pp. 754-756
S.M. Swetter, J.C. Boldrick, P. Pierre, P. Wong, B.M. Egbert.
Effects of biopsy-induced wound healing on residual basal cell and squamous cell carcinomas: rate of tumor regression in excisional specimens.
J Cutan Pathol, 30 (2003), pp. 139-146
K.A. Holmkvist, G.S. Rogers, P.R. Dahl.
Incidence of residual basal cell carcinoma in patients who appear tumor free after biopsy.
J Am Acad Dermatol, 41 (1999), pp. 600-605
J. Alcalay, R. Alkalay, B. Hazaz.
Residual skin cancer after preoperative biopsy: evaluation by Mohs micrographic surgery.
Int J Dermatol, 43 (2004), pp. 456-458
W.R. Levis, K.H. Kraemer, W.G. Klingler, G.L. Peck, W.D. Ferry.
Topical immunotherapy of basal cell carcinomas with dinitrochlorobenzene.
Cancer Res, 33 (1973), pp. 3036-3042
J.M. Spencer, A. Tannenbaum, L. Sloan, R.A. Amonette.
Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation?.
Dermatol Surg, 23 (1997), pp. 625-630
K. Nouri, J.M. Spencer, J.R. Taylor, M. Hayag, J. DeVoursney, N. Shah.
Does wound healing contribute to the eradication of basal cell carcinoma following curettage and electrodessication?.
Dermatol Surg, 25 (1999), pp. 183-187
S.M. Swetter, D. Yaghmai, B.M. Egbert.
Infiltrative basal cell carcinoma occurring in sites of biopsy-proven nodular basal cell carcinoma.
J Cutan Pathol, 25 (1998), pp. 420-425
R.E. Lauritzen, R.E. Johnson, J.S. Spratt Jr.
Pattern of recurrente in basal cell carcinoma.
Surgery, 57 (1965), pp. 813-816
R.P. Rapini.
Comparison of methods for checking surgical margins.
J Am Acad Dermatol, 23 (1990), pp. 288-294
A. Kimyai-Asadi, L.H. Goldberg, M.H. Jih.
Accuracy of serial transverse cross-sections in detecting residual basal cell carcinoma at the surgical margins of an elliptical excision specimen.
J Am Acad Dermatol, 53 (2005), pp. 469-474
D.J. Wolf, J.A. Zitelli.
Surgical margins for basal cell carcinoma.
Arch Dermatol, 123 (1987), pp. 340-344
H. Breuninger, K. Dietz.
Prediction of subclinical tumor infiltration in basal cell carcinoma.
J Dermatol Surg Oncol, 17 (1991), pp. 574-578
A.W. Wilson, G. Howsam, V. Santhanam, D. Macpherson, J. Grant, C.A. Pratt, et al.
Surgical management of incompletely excised basal cell carcinomas of the head and neck.
Br J Oral Maxillofac Surg, 42 (2004), pp. 311-314
G.G. Hallock, D.A. Lutz.
A prospective study of the accuracy of the surgeon's diagnosis and significance of positive margins in nonmelanoma skin cancers.
Plast Reconstr Surg, 107 (2001), pp. 942-947
E. Nagore, C. Grau, J. Molinero, J.M. Fortea.
Positive margins in basal cell carcinoma: relationship to clinical features and recurrence risk. A retrospective study of 248 patients.
J Eur Acad Dermatol Venereol, 17 (2003), pp. 167-170
C.A. Gooding, G. White, M. Yatsuhashi.
Significance of marginal extension in excised basal-cell carcinoma.
N Engl J Med, 273 (1965), pp. 923-924
F.F. Liu, E. Maki, P. Warde, D. Payne, P. Fitzpatrick.
A management approach to incompletely excised basal cell carcinomas of skin.
Int J Radiat Oncol Biol Phys, 20 (1991), pp. 423-428
H.I. Friedman, T. Williams, S. Zamora, Z.A. al Assaad.
Recurrent basal cell carcinoma in margin-positive tumors.
Ann Plast Surg, 38 (1997), pp. 232-235
J.K. Robinson, S.G. Fisher.
Recurrent basal cell carcinoma after incomplete resection.
Arch Dermatol, 136 (2000), pp. 1318-1324
J.D. Richmond, R.M. Davie.
The significance of incomplete excision in patients with basal cell carcinoma.
Br J Plast Surg, 40 (1987), pp. 63-67
C. Rogalski, F. Kauer, J.C. Simon, U. Paasch.
Meta-analysis of published data on incompletely excised basal cell carcinomas of the ear and nose with introduction of an innovative treatment strategy.
J Dtsch Dermatol Ges, 5 (2007), pp. 118-126
R.W. Griffiths, S.K. Suvarna, J. Stone.
Basal cell carcinoma histological clearance margins: an analysis of 1,539 conventionally excised tumours. Wider still and deeper?.
J Plast Reconstr Aesthet Surg, 60 (2007), pp. 41-47
J.P. Sloane.
The value of typing basal cell carcinomas in predicting recurrence after surgical excision.
Br J Dermatol, 96 (1977), pp. 127-132
S. Boulinguez, C. Grison-Tabone, L. Lamant, S. Valmary, R. Viraben, J.M. Bonnetblanc, et al.
Histological evolution of recurrent basal cell carcinoma and therapeutic implications for incompletely excised lesions.
Br J Dermatol, 151 (2004), pp. 623-626
L.A. Sussman, D.F. Liggins.
Incompletely excised basal cell carcinoma: a management dilemma?.
Aust N Z J Surg, 66 (1996), pp. 276-278
N.R. Telfer, G.B. Colver, P.W. Bowers.
Guidelines for the management of basal cell carcinoma. British Association of Dermatologists.
Br J Dermatol, 141 (1999), pp. 415-423
W. Sterry.
Guidelines: the management of basal cell carcinoma.
Eur J Dermatol, 16 (2006), pp. 467-475
M. Dandurand, T. Petit, P. Martel, B. Guillot.
Management of basal cell carcinoma in adults Clinical practice guidelines.
Eur J Dermatol, 16 (2006), pp. 394-401
A. Bogdanov-Berezovsky, A. Cohen, R. Glesinger, E. Cagnano, Y. Krieger, L. Rosenberg.
Clinical and pathological findings in reexcision of incompletely excised basal cell carcinomas.
Ann Plast Surg, 47 (2001), pp. 299-302
R.R. Pascal, L.W. Hobby, R. Lattes, G.F. Crikelair.
Prognosis of “incompletely excised” versus “completely excised” basal cell carcinoma.
Plast Reconstr Surg, 41 (1968), pp. 328-332
S.P. De Silva, A.L. Dellon.
Recurrence rate of positive margin basal cell carcinoma: results of a five-year prospective study.
J Surg Oncol, 28 (1985), pp. 72-74
J. Berlin, K.H. Katz, K.F. Helm, M.E. Maloney.
The significance of tumor persistence after incomplete excision of basal cell carcinoma.
J Am Acad Dermatol, 46 (2002), pp. 549-553
C.W. Spraul, W.M. Ahr, G.K. Lang.
Clinical and histologic features of 141 primary basal cell carcinomas of the periocular region and their rate of recurrence after surgical excision.
Klin Monatsbl Augenheilkd, 217 (2000), pp. 207-214
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