Incomplete removal of basal cell carcinoma: what is the value of further surgery?

INTRODUCTION: Surgical management of skin cancer is an important part of modern maxillofacial surgery. The common tumours treated are squamous cell carcinoma, malignant melanoma and some benign lesions, but the largest group of tumours are the basal cell carcinomas. Although only locally aggressive, if they are not completely removed, recurrence may occur and be troublesome, especially in the head and neck. Even in this region, incomplete excision is uncommon, less than 20 %, but management of positive margins remains controversial. This review evaluates the effectiveness of a further surgical intervention after a positive margin. MATERIALS AND METHODS: A retrospective audit was undertaken to determine the rate of positive margins within the unit and subsequently the percentage of residual tumour found in any secondary excisions. RESULTS: The results show that in a sample of 247 patients, 11 % had positive peripheral margins. A second excision only showed that 36 % had any evidence of residual tumour. DISCUSSION: The study raises the question of the value of further surgery. Finally, the authors suggest a more focused approach to the finding of a positive margin before the patient is offered more treatment.