Introduction and Aims: Ascertain how significant the reduction in incomplete excision would be with an increase in surgical excision margins. Identify any patterns of incomplete excision.
Methods: Data was collected retrospectively in the first cycle from 2007 to 2010. The implemented change was to increase the excision margin from 3-4 to 4-5mm and to compare results with gold standard dermatology guidelines (Telfer et al). The second cycle involved retrospective data collection from 2011 to 2012. Both patient demographics and pathology demographics such as the number of lesions, facial subunit, histology and completeness of excision were collected.
Results: The majority of lesions were Basal Cell carcinomas (117/151 in the first and 110/205 in the second cycles) affecting either the nose or ears of older patients in both cycles. Over half the incomplete excisions were involving the ear. 9.9% (15/151) were incompletely excised in the first cycle compared with 4.4% (9/205) in the second cycle (P=0.053). 11.1% (1/9) of the incompletely excised cases in the second cycle resulted in recurrence over an average of 17 months follow up.
Conclusions: There was an appreciable reduction in incomplete excision with increase in surgical margins. Margins are more difficult to achieve in certain facial subunits of ear e.g conchal bowl and nose e.g. columella. Consider the original size of the lesion and pre-clinical suspicion with planning excision margins. Incomplete excision will not always lead to recurrence.