SRS315 - Does the use of surgical loupes improve surgical margins in Basal cell carcinoma excision? A systematic review

Abstract Background Incomplete excision of facial basal cell carcinoma (BCC) increases recurrence, morbidity, and re-operation. Surgeons often rely on their naked-eye when assessing margins; whether loupe magnification reduces incomplete excision remains uncertain. Methods We are the first to search MEDLINE and Embase for comparative studies of loupe or high magnification versus standard clinical assessment in facial BCC excision. We found three trials (Sugrue 2017, Hoefkens 2014, Wettstein 2006) involving 182 lesions to be eligible. The primary outcome was incomplete excision at first resection. Odds ratios (ORs) were pooled using fixed- and random-effects models with heterogeneity assessment. Additionally, a prospective single-arm loupe series (Jallali 2004, 105 BCCs) was included narratively. Results Incomplete excisions were: Sugrue, 1/47 (loupe) versus 2/47 (no loupe); Hoefkens, 3/45 versus 3/45; Wettstein, 0/20 versus 6/20. The pooled fixed-effect OR was 0.50 (95% c.i. 0.15–1.75); random-effects OR 0.44 (95% c.i. 0.10–1.99). We found heterogeneity to be low (I² = 26%). Jallali’s series reported a 3.8% incomplete rate with loupe use, favourable compared with large historical audits on BCC removal without loupes (6–14%). Conclusions Our meta-analysis suggests loupe magnification halves the odds of incomplete excision in facial BCC, although confidence intervals are wide due to small sample sizes. Supportive cohort data reinforces our association between magnification and low incomplete rates. Larger multicentre randomised studies are required to confirm these findings and inform surgical margin guidelines.