Información de la revista
Vol. 98. Núm. 10.
Páginas 679-687 (Diciembre 2007)
Vol. 98. Núm. 10.
Páginas 679-687 (Diciembre 2007)
Controversies in dermatology
Acceso a texto completo
Management of Basal Cell Carcinomas With Positive Margins
Actitud Ante Los Epiteliomas Basocelulares Con Bordes Afectos
Visitas
...
L. Ríos-Buceta??
Autor para correspondencia
luisriosbuceta@terra.es

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
Información del artículo
Abstract

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
treatment
surgery
cancer
skin
Resumen

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.

Palabras clave:
epitelioma
basocelular
tratamiento
cirugía
cáncer
piel
El Texto completo está disponible en PDF
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