Margin Involvement After Excision with Preoperative Dermoscopic Assessment of Head and Neck Basal Cell Carcinomas - a Retrospective Study

Laura Ziuzia-Januszewska,1 Irena Walecka,2 Małgorzata Kołos,3 Damian Zimoń,2 Marcin Januszewski,4 Eliza Brożek-Mądry1 1Department of Otorhinolaryngology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland; 2Department of Dermatology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland; 3Department of Pathomorphology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland; 4Department of Gynecology, Oncological Gynecology and Reproduction, National Medical Institute of the Ministry of Interior and Administration, Warsaw, PolandCorrespondence: Laura Ziuzia-Januszewska, Department of Otorhinolaryngology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, Warsaw, 02-507, Poland, Tel +48-477221182, Email [email protected]: Basal cell carcinoma (BCC) is the most common cancer in Caucasians, and its incidence is rising. Incompletely treated tumors may cause destruction of adjacent structures and significant morbidity. This study aimed to evaluate margin involvement after surgical BCC excision with preoperative dermoscopic assessment and identify tumor features associated with positive and inadequate margins.Methods: We retrospectively analyzed electronic medical records of 230 head and neck BCCs, surgically excised after preoperative dermoscopic border assessment.Results: Overall, 14 cases (6.2%) had positive margins, and 35 (16.1%) had inadequate (positive or close) margins. Lateral margins were positive and inadequate in 8 (3.5%) and 16 (7%) cases, respectively, while deep margins in 11 (4.8%) and 27 (12.6%) cases, respectively. The observed rate of lateral margin positivity is notably low compared to prior reports. Recurrence occurred in 2.8% of cases. Factors associated with inadequate margins included H-zone location (OR=3 [95% CI 1.1– 8.1]), particularly on the nose (OR=2.3 [95% CI 1.1– 4.8]), aggressive histological subtypes (OR=4.3 [95% CI 1.7– 11.1]), ulceration (OR=2.3 [95% CI 1.1– 4.8]), inflammatory infiltration (OR=3.9 [95% CI 1.7– 8.7]), and elastosis (OR=2.9 [95% CI 1.2– 6.8]). Lateral inadequate margin was more frequent in recurrent tumors (OR 5.3 [95% CI 1.6– 16.9]).Conclusion: This study supports the role of preoperative dermoscopic lesion borders assessment and multidisciplinary approach in BCC treatments, especially for high-risk tumors when micrographic surgery is not feasible. While further randomized controlled trials are warranted, incorporating preoperative dermoscopic assessment of BCC borders into clinical practice could improve patient outcomes and reduce healthcare costs.Plain Language Summary: Basal cell carcinoma (BCC) is the most common type of skin cancer, especially in Caucasians, and its numbers are increasing. If BCC is not completely removed, it can cause damage to surrounding tissues. This study looked at how often BCCs are not completely excised when using a skin examination method called dermoscopy before surgery.We analyzed medical records from 230 BCCs on the head or neck, all of which were surgically removed after dermoscopy was used to examine the edges of the tumor. The study found that in 3.5% of the cases, side margins were positive, which means that cancer cells were present in the cut line, indicating that cancer tissue was not completely removed. This rate is low compared to the literature.The findings suggest that using dermoscopy before surgery to find the tumor’s borders might help surgeons remove the cancer more accurately. This could reduce the need for additional surgeries and help lower healthcare costs. While the study encourages further research to confirm this conclusion, it suggests that using dermoscopy before surgery could be a useful tool for improving outcomes for patients and overall healthcare efficiency.Keywords: basal cell carcinoma, skin neoplasms, surgical margins, dermoscopy, risk factors, recurrence