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• W2040673731 abstract "For 1378 patients treated in the 11 years 1988–1998 by conventional excision of 1635 basal cell carcinomas, 1516 first index lesions were histologically completely excised.All patients having more than one BCC excised were identified from the data base from 1988 to 2003 to give minimum 5 years follow for last treated primary lesions in 1998. Measured clearance margins around the initial lesions at or near sites of presumptive recurrent lesions were noted and the lesions recorded photographically. All incompletely excised lesions whether or not re-excised were excluded.The median age for all patients was 70 years. Over minimum 5 years follow up, six patients developed nine subsequent lesions contiguous with the scar or graft repair of primary index lesion excision site (probable recurrences). The median interval to recurrence was 41 months (4 months–8 years 10 months), with median lateral clearance margin around the primary tumour of 2 mm (0.3–6.8 mm).A further nine patients developed 11 new lesions near (within 1 cm of) the scar or graft of primary index lesion excision site (possible recurrences). The median interval to recurrence was 59 months (1 year–8 years 6 months). The median lateral clearance margin around the primary tumour was 4.1 mm (0.8–5.8 mm). For the two groups combined the maximum recurrence rate expressed as a percentage of index lesions was 1.3% (20/1516). Two thirds of possible and probable recurrences occurred in the temple and forehead, although these sites represented only 22% of all lesions, which may rather suggest new lesions in an area of field change as opposed to residual disease.The measured clearance margins reported here perhaps suggest that some original lesions may well have been completely excised primarily and many ‘recurrences’ were new primaries.These figures indicate there is a low order of probability for the incidence of recurrent basal cell carcinoma during minimum 5 years follow period after conventional surgical excision and conventional histological assessment of tumour resection margins. For 1378 patients treated in the 11 years 1988–1998 by conventional excision of 1635 basal cell carcinomas, 1516 first index lesions were histologically completely excised. All patients having more than one BCC excised were identified from the data base from 1988 to 2003 to give minimum 5 years follow for last treated primary lesions in 1998. Measured clearance margins around the initial lesions at or near sites of presumptive recurrent lesions were noted and the lesions recorded photographically. All incompletely excised lesions whether or not re-excised were excluded. The median age for all patients was 70 years. Over minimum 5 years follow up, six patients developed nine subsequent lesions contiguous with the scar or graft repair of primary index lesion excision site (probable recurrences). The median interval to recurrence was 41 months (4 months–8 years 10 months), with median lateral clearance margin around the primary tumour of 2 mm (0.3–6.8 mm). A further nine patients developed 11 new lesions near (within 1 cm of) the scar or graft of primary index lesion excision site (possible recurrences). The median interval to recurrence was 59 months (1 year–8 years 6 months). The median lateral clearance margin around the primary tumour was 4.1 mm (0.8–5.8 mm). For the two groups combined the maximum recurrence rate expressed as a percentage of index lesions was 1.3% (20/1516). Two thirds of possible and probable recurrences occurred in the temple and forehead, although these sites represented only 22% of all lesions, which may rather suggest new lesions in an area of field change as opposed to residual disease. The measured clearance margins reported here perhaps suggest that some original lesions may well have been completely excised primarily and many ‘recurrences’ were new primaries. These figures indicate there is a low order of probability for the incidence of recurrent basal cell carcinoma during minimum 5 years follow period after conventional surgical excision and conventional histological assessment of tumour resection margins. Surgical excision may be regarded as optimal treatment of basal cell carcinomas. Complete excision should cure the condition with results for conventional complete surgical excision, in over 3500 cases giving local recurrence rates over varying periods of follow up observation in the range 0.35–1.9%.1Pascal R.R. Hobby L.W. Lattes R. Crikelair G.F. Prognosis of ‘incompletely excised’ versus ‘completely excised’ basal cell carcinoma.Plast Reconstr Surg. 1968; 41: 328-332Google Scholar, 2Emmett A.J.J. Broadbent G.G. Basal cell carcinoma in Queensland.Aust N Z J Surg. 1981; 51: 576-590Google Scholar, 3Breuninger H. Schaumburg-Lever G. Control of excisional margins by conventional histopathological techniques in the treatment of skin tumours. An alternative to Mohs' technique.J Pathol. 1988; 154: 167-171Google Scholar, 4Soutar D.S. Tiwari R. The skin.in: Soutar D.S. Tiwari R. Excision and reconstruction in head and neck cancer. Churchill Livingstone, Edinburgh1994: 369-387Google Scholar, 5Park A.J. Strick M. Watson J.D. Basal cell carcinomas: do they need to be followed up?.J R Coll Surg Edinb. 1994; 39: 109-111Google Scholar Higher 5 years recurrence rates of 14 and 23% for 239 cases have been reported6Hauben D.J. Zirkin H. Mahler D. Sacks M. The biologic behavior of basal cell carcinoma; analysis of recurrence in excised basal cell carcinoma: part II.Plast Reconstr Surg. 1982; 69: 110-116Google Scholar, 7Nagore E. Grau C. Molinero J. Fortea J.M. Positive margins in basal cell carcinoma; relationship to clinical features and recurrence risk. A retrospective study of 248 patients.J Eur Acad Dermatol Venereol. 2003; 17: 167-170Google Scholar although criteria for complete excision are not uniform, and the validity of some of these data has given rise to vigorous debate.8Dzubow L.E. Recurrent basal cell carcinoma.Plast Reconstr Surg. 1982; 70: 405Google Scholar, 9Olshansky K. Recurrent basal cell carcinoma.Plast Reconstr Surg. 1982; 70: 512Google Scholar, 10Ley R.D. Recurrent basal cell carcinoma.Plast Reconstr Surg. 1982; 70: 512-513Google Scholar, 11Koss N. Recurrent basal cell carcinoma, reply.Plast Reconstr Surg. 1982; 70: 514Google Scholar None of these studies,1Pascal R.R. Hobby L.W. Lattes R. Crikelair G.F. Prognosis of ‘incompletely excised’ versus ‘completely excised’ basal cell carcinoma.Plast Reconstr Surg. 1968; 41: 328-332Google Scholar, 2Emmett A.J.J. Broadbent G.G. Basal cell carcinoma in Queensland.Aust N Z J Surg. 1981; 51: 576-590Google Scholar, 3Breuninger H. Schaumburg-Lever G. Control of excisional margins by conventional histopathological techniques in the treatment of skin tumours. An alternative to Mohs' technique.J Pathol. 1988; 154: 167-171Google Scholar, 4Soutar D.S. Tiwari R. The skin.in: Soutar D.S. Tiwari R. Excision and reconstruction in head and neck cancer. Churchill Livingstone, Edinburgh1994: 369-387Google Scholar, 5Park A.J. Strick M. Watson J.D. Basal cell carcinomas: do they need to be followed up?.J R Coll Surg Edinb. 1994; 39: 109-111Google Scholar, 6Hauben D.J. Zirkin H. Mahler D. Sacks M. The biologic behavior of basal cell carcinoma; analysis of recurrence in excised basal cell carcinoma: part II.Plast Reconstr Surg. 1982; 69: 110-116Google Scholar, 7Nagore E. Grau C. Molinero J. Fortea J.M. Positive margins in basal cell carcinoma; relationship to clinical features and recurrence risk. A retrospective study of 248 patients.J Eur Acad Dermatol Venereol. 2003; 17: 167-170Google Scholar however, documented measured lateral and deep clearance margins around the initial primary tumours, or illustrated presumptive recurrences with photographs. Measured clearance margins and photographic comparison of new lesions with initial lesions will assist in judging if a new lesion is likely to be a recurrence, or a new primary adjacent to a site of previous surgical scarring. Minimum 5 years follow up should detect 82% of recurrences,12Rowe D.E. Comparison of treatment modalities for basal cell carcinoma.Clin Dermatol. 1995; 13: 617-620Google Scholar but a further 18% of recurrences may occur 6–10 years post treatment. Because not all patients will live for 5 years after initial treatment, results can be expressed both in terms of all patients initially treated and also in terms of the observed 5 years survivors (with or without recurrence)—the so called determinate patients.13Mohs F.E. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future.J Dermatol Surg Oncol. 1978; 4: 41-54Google Scholar Although advocates of Mohs' micrographic surgery have suggested that recurrence rates after conventional surgical excision are higher than after Mohs' surgery, Mohs' surgery itself is associated with 5 years recurrence rates of 0.7–2.6% for 2960 BCCs and for 7257 BCCs.13Mohs F.E. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future.J Dermatol Surg Oncol. 1978; 4: 41-54Google Scholar, 14Rigel D.S. Robins P. Friedman R.J. Predicting recurrence of basal cell carcinomas treated by microscopically controlled excision. A recurrence index score.J Dermatol Surg Oncol. 1981; 7: 807-810Google Scholar The only 5 years UK figures show for 141 lesions, recurrences for 1.7% primary excisions and a recurrence rate of 4.8% for recurrent (previously treated) lesions.15Julian C.G. Bowers P.W. A prospective study of Mohs' micrographic surgery in two English centres.Br J Dermatol. 1997; 136: 515-518Google Scholar It would, therefore, be valuable to carefully define the incidence of local basal cell carcinoma recurrence after conventional surgical excision. Published reviews of collected series rarely record if tumours which recur over 5 years follow up after excision by conventional surgery, were in fact initially completely excised histologically,16Rowe D.E. Carroll R.J. Day C.L. Long term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up.J Dermatol Surg Oncol. 1989; 15: 315-328Google Scholar, 17Rowe D.E. Carroll R.J. Day C.L. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma.J Dermatol Surg Oncol. 1989; 15: 424-431Google Scholar making it difficult to know the correct rate of local tumour recurrence after defined complete tumour excision. The importance of differentiating true recurrences from new lesions, which may arise at, or adjacent to sites of previous treatment has been emphasised.18Hirsch P. False negative margins.J Dermatol Surg Oncol. 1989; 15: 452-453Google Scholar, 19Wagner R.F. New primary basal cell carcinomas arising in skin flaps following Mohs micrographic surgery for primary and recurrent basal cell carcinoma.J Dermatol Surg Oncol. 1990; 16: 1044-1047Google Scholar Local recurrence is defined as ‘a lesion arising in the same or contiguous site’,20Robins P. Chemosurgery; my 15 years of experience.J Dermatol Surg Oncol. 1981; 7: 779-789Google Scholar and Goldberg et al.21Goldberg L. Stal S. Spira M. Recognition and treatment of recurrent basal cell carcinoma.Ann Plast Surg. 1983; 11: 313-318Google Scholar distinguished continued growth of a tumour left in the immediate area becoming clinically manifest months or years after incomplete removal, from new tumour formation in the immediate area of the previous tumour site which cannot be differentiated from the old lesion because of proximity of location to the scar. Clinical discontinuity between the new lesion and the previous scar or graft appears to be crucial to the differentiation. However, in publications to date lack of sequential photographic documentation, and absence of measured excision margins around primary index tumours has made these differentiations difficult in practice. A previous preliminary report22Griffiths R.W. The case for other surgical options.in: Ross D. Spittle M. Key advances in the clinical management of skin cancer. Royal Society of Medicine Press, London2004Google Scholar indicated probable or possible basal cell carcinoma recurrences were infrequent after conventionally assessed histologically complete excision. For an expanded period of 11 years of patient accrual we have analysed the case notes and photographic records of consecutive patients with basal cell carcinomas treated under one surgeon's care from 1988 to 1998—allowing a potential minimum 5 years follow up to the end of 2003. Specifically, deep and lateral histological clearance margins were measured for all primary lesions, at which excision sites subsequent metachronous lesions arose contiguous with or closely adjacent to (within 1 cm) scar or graft (probable or possible local recurrences). The data base of consecutive patients having basal cell carcinomas excised under the care of one consultant for the 11 years from 1988 to 1998 was studied. The total number of patients and total number of lesions were noted. All first lesions treated in the period were designated index lesions. Second lesions identified either in the 1988–1998 period or subsequent 5 years 1999–2003 were studied to determine if they could reasonably be considered from their position, to represent possible or probable recurrences. All patients undergoing more than one episode of care for basal cell carcinoma, in the 16 years from 1988 to the end of 2003 were identified in order to study possible and probable tumour recurrences after complete primary lesion excision. This timescale provided a potential minimum period of 5 years to elapse after the last treated patient received their primary surgery in 1998. All patients with more than one treatment episode had their discharge summaries, notes and photographs studied in order to define those in which any subsequent treatment episode after the primary episode involved treating a new basal cell carcinoma which was contiguous with, or closely adjacent to (within 1 cm of) the previous scar or skin graft or skin flap.18Hirsch P. False negative margins.J Dermatol Surg Oncol. 1989; 15: 452-453Google Scholar, 19Wagner R.F. New primary basal cell carcinomas arising in skin flaps following Mohs micrographic surgery for primary and recurrent basal cell carcinoma.J Dermatol Surg Oncol. 1990; 16: 1044-1047Google Scholar, 20Robins P. Chemosurgery; my 15 years of experience.J Dermatol Surg Oncol. 1981; 7: 779-789Google Scholar All histological material for these patients with putative recurrences was reviewed to confirm the lateral and deep clearance margins of normal tissue. Since, there was no Mohs' surgery service available locally during the study period, it was assumed that patients developing further basal cell carcinomas (metachronous lesions or recurrences) after primary surgery, would be referred back to the plastic surgeon who had performed the initial surgery.5Park A.J. Strick M. Watson J.D. Basal cell carcinomas: do they need to be followed up?.J R Coll Surg Edinb. 1994; 39: 109-111Google Scholar This assumption seemed justified because of close links with local dermatology and general practitioner colleagues both informal and formal through local multi-disciplinary team (MDT) structures and regular Skin Cancer Network Group meetings. However, the possibility that not all ‘recurrences’ returned to the plastic surgery unit does exist. The patients were mostly tertiary referrals from dermatologist or oncologist colleagues, with less than 10% of patients being referred from general practice. Therefore, the patient group was selective for either large or awkwardly placed lesions in areas which could require skin graft or flap repair, and this gives bias to this patient population away from comparatively simple, easy to treat lesions. The major changes that we have seen over the last 15 years include more detailed examination of the skin resection specimens. In this manner, we have now introduced inking of particular margins of specimens with careful block sampling according to the orientation of the specimen, usually in a bread-slice fashion. This has taken the place of the ‘hot cross bun’ and single transverse slice sections that used to be the norm. In addition, all of the resection sample is now likely to be processed compared with previously. On infrequent occasions, frozen section sampling can be taken for awkward sites such as around face/nose/eyes. Cross comparison against previous biopsies is also regularly undertaken with review of previous biopsies from other sites and review in multi-disciplinary team (MDT) format. Proforma reporting styles according to the Royal College of Pathologists currently are in place.23Slater D.N. McKee P.H. Minimum dataset for the histopathological reporting of common skin cancers.Standards and minimum datasets for reporting cancers. Royal College of Pathologists, London2002Google Scholar The surgical practice in this period was to perform as many procedures as possible as day cases under local anaesthetic. Lesions were photographed and loupe magnification (×3.5) was routinely used.24Bentkover S.H. Grande D.M. Soto H. Kozlicak B.A. Guillaume D. Girouard S. Excision of head and neck basal cell carcinoma with a rapid, cross sectional, frozen section technique.Arch Facial Plast Surg. 2002; 4: 114-119Google Scholar, 25Netscher D.T. Spira M. Basal cell carcinoma: an overview of tumor biology and treatment.Plast Reconstr Surg. 2004; 113: 74e-94eGoogle Scholar, 26Jallali N. Loupe magnification reduces the incidence of incomplete excision of basal cell carcinoma.Plast Reconstr Surg. 2004; 113: 1887-1888Google Scholar The excision margin was marked around the assessed dotted outline of the tumour before the infiltration of 0.5% lignocaine/1:2 000 000 adrenaline. Margins of 2–3 mm were marked around tumours with a distinct margin, with 5 mm used around less distinct bordered lesions. A marker suture was placed at the 12 O'clock position on the specimen to assist in orientation during histopathological assessment. If there was concern about completeness of excision, peripheral and/or deep biopsies beyond the main resection specimen were taken and either submitted to frozen section or paraffin section analysis. The policy was to re-excise the site of any lesion reported as incompletely excised. Only if the patient declined would irradiation or long term observation be considered. Determinate patients (those surviving 5 years or more after surgery or dying within 5 years of BCC) are not likely to be less than 60% of the total (we have previously shown for squamous cell carcinoma (SCC) that 40% will died within 5 years of unrelated disease).27Griffiths R.W. Feeley K. Suvarna S.K. Audit of clinical and histological prognostic factors in primary invasive squamous cell carcinoma of the skin: assessment in a minimum 5 year follow up study after conventional excisional surgery.Br J Plast Surg. 2002; 55: 287-292Google Scholar Thus results are expressed in terms of the whole cohort and then the likely number of determinate patients, (assuming that for BCC patients, at least 60% would be determinate as they tend to be younger than patients with SCC). Written permission to use clinical photographs was obtained from all patients, and in one instance from the next of kin for a patient who died of unrelated disease in 1999. In the period 1988–1998 (11 years) 1378 patients (median age 70 years) were treated with conventional surgical excision for 1635 first index basal cell carcinomas. One hundred and nineteen (7%) were reported as incompletely excised and the policy was to re-excise these. In practice 91/119 (76%) were re-excised with residual tumour found in 48/91 (53%). Of the 1516 lesions that were judged primarily completely excised by conventional histological techniques, six patients subsequently developed nine new lesions contiguous with the primary treatment site (scar or graft), Table 1. Patients 1 and 3 had previous treatment before being referred for plastic surgery. Patient 1 had the upper lip BCC first excised in 1980 by a dermatologist and the first recurrence was treated in 1983 by irradiation. His first plastic surgery excision of the next recurrence was before this review period in 1986 with a deep resection clearance margin of 8.2 mm and lateral resection margin clearance of 0.4 mm. Patient 3 had an excision of a right forehead BCC in 1987 and BCC right temple and right forehead in 1988 by the dermatologist. In 1989, she was referred for plastic surgery when an index BCC of right temple was excised completely.Table 1Data for six patients with probable recurrencesPatient numberSexAge at first operationInterval between first and subsequent operationsSiteIndex lesions deep resection margin clearanceIndex lesions lateral resection margin clearance1M785 years 9 monthsUpper lip11.12.22F674 years 8 months; 1 year 7 monthsForehead; forehead3.4; 0.50.3; 2.83F531 year; 8 years 10 months; 2 years 2 monthsR temple; R temple; L temple1.9; 2.4; 2.52; 0.3; 1.54F784 monthsForehead1.96.85F742 years 3 monthsGlabella3.31.46M664 years 3 monthsPostauricular2.35.3Median6941 months2.42Range(53–78)(4 months–8 years 10 months)(0.5–11.1)(0.3–6.8) Open table in a new tab Six of the nine were on the temple or forehead. Seven developed in the period 1988–1998 and two between 1999 and 2003. These were designated probable recurrences, shown in Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6. The mean interval to probable recurrences was 41 months (4 months–8 years 10 months). For probable recurrences the median lateral resection clearance margin was 2 mm (range 0.3–6.8), and the median deep resection margin clearance was 2.4 mm (range 0.5–11.1). For probable recurrences only two lateral clearance resection margins were <1 mm, and only one deep clearance resection margin was less than 1 mm.Figure 2Patient 2: (A) left forehead index lesion, (B) left forehead second lesion at lower limit of scar 4 years 8 months later, (C) left forehead third lesion at right lower limit of skin graft 1 year 7 months after second lesion appearance.View Large Image Figure ViewerDownload (PPT)Figure 3Patient 3: (A) right temple second lesion at lateral limit of scar of index lesion excision 1 year earlier, (B) left temple index lesion, (C) right temple third lesion just above upper edge of skin graft 8 years 10 months after second lesion excision, (D) left temple second lesion 2 years 2 months after excision of index lesion.View Large Image Figure ViewerDownload (PPT)Figure 4Patient 4 index lesion left forehead, the second lesion developed 4 months later as a crust at the 6 O'clock position on the edge of the graft (recorded diagramatically in the notes but not photographed).View Large Image Figure ViewerDownload (PPT)Figure 5Patient 5: (A) index lesion of glabella skin, (B) the second lesion 2 years 3 months later.View Large Image Figure ViewerDownload (PPT)Figure 6Patient 6: (A) index lesion of left post-auricular skin, (B) second lesion at the lower graft edge 4 years 3 months later.View Large Image Figure ViewerDownload (PPT) A further 11 new lesions developed in nine patients near (within 1 cm of) the original scar or graft and were designated possible recurrences, Table 2.Table 2Data for nine patients with possible recurrencesPatient numberSexAge at first operationInterval between first and subsequent operationsSiteIndex lesions deep resection margin clearanceIndex lesions lateral resection margin clearance1F778 years 6 monthsScalp3.14.52M68; 702 years 6 months; 5 yearsScalp; scalp3.3; 4.24.1; 43F615 yearsForehead2.43.44M635 years 8 monthsTemple35.35F708 yearsTemple2.92.96F527 yearsNose20.87F855 yearsTemple3.83.78M545 yearsTemple1.25.89M75; 751 year; 1 yearTemple; temple4; 4.34.5; 3.6Median6859 months3.14.1Range(52–85)(1 year–8 years 6 months)(1.2–4.3)(0.8–5.8) Open table in a new tab Seven of eleven were sited in the forehead or temple. Six developed between 1988–1998 and five in 1999–2003. The mean interval to possible recurrences was 59 months (12 months–8 years 6 months). For possible recurrences the median lateral resection margin clearance was 4.1 mm (range 0.8–5.8), and median deep resection clearance margin was 3.1 mm (range 1.2–4.3). Only one lateral clearance margin was <1 mm. There were no deep clearance margins <1 mm. Patient ages, sex, site of lesions and the intervals to second tumour appearance are given together with the deep and lateral nontumour tissue clearances around the primary lesion are given in Table 1, Table 2. Thus as percentages of all lesions initially completely excised there were 0.6% probable local recurrences, and 0.72% possible recurrences. Combining these figures produces a ‘maximum’ recurrence rate of 20/1516 (1.3%). Mohs13Mohs F.E. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future.J Dermatol Surg Oncol. 1978; 4: 41-54Google Scholar defined determinate patients as those who survived 5 years after initial treatment—differentiating these from patients dying within 5 years of other disease unrelated to basal cell carcinoma. He expressed his results in relation to determinate patients rather than the whole initial cohort. We can apply such an adjustment to the present series, and assume that 40% of patients died within 5 years of other disease (as we have found for cutaneous squamous cell carcinoma patients27Griffiths R.W. Feeley K. Suvarna S.K. Audit of clinical and histological prognostic factors in primary invasive squamous cell carcinoma of the skin: assessment in a minimum 5 year follow up study after conventional excisional surgery.Br J Plast Surg. 2002; 55: 287-292Google Scholar with median age 76). It is likely that as BCC patients were younger, less than 40% would die of other causes in the 5 years, but the 60% determinate figure has been retained as it would if anything overestimate the likely recurrence rate for these patients. [For the present series in which median age for all patients was 70 years, and for those with probable or possible recurrences median ages were 68 and 69 years, if it is assumed that 60% of the original patients remain alive for 5 years follow up, these figures for determinate surviving patients adjust to probable recurrence 9/910 (0.98%), possible 11/910 (1.2%), and probable and possible combined 20/910 (2%)]. Despite the theoretical advantage of more extensive histological assessment of excision margins for BCC with Mohs' micrographic surgery, the 5 years recurrence rates for BCC after complete excision by either Mohs' surgery or conventional surgery are similar in the range 0.35–2.6%.1Pascal R.R. Hobby L.W. Lattes R. Crikelair G.F. Prognosis of ‘incompletely excised’ versus ‘completely excised’ basal cell carcinoma.Plast Reconstr Surg. 1968; 41: 328-332Google Scholar, 2Emmett A.J.J. Broadbent G.G. Basal cell carcinoma in Queensland.Aust N Z J Surg. 1981; 51: 576-590Google Scholar, 3Breuninger H. Schaumburg-Lever G. Control of excisional margins by conventional histopathological techniques in the treatment of skin tumours. An alternative to Mohs' technique.J Pathol. 1988; 154: 167-171Google Scholar, 4Soutar D.S. Tiwari R. The skin.in: Soutar D.S. Tiwari R. Excision and reconstruction in head and neck cancer. Churchill Livingstone, Edinburgh1994: 369-387Google Scholar, 5Park A.J. Strick M. Watson J.D. Basal cell carcinomas: do they need to be followed up?.J R Coll Surg Edinb. 1994; 39: 109-111Google Scholar, 13Mohs F.E. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future.J Dermatol Surg Oncol. 1978; 4: 41-54Google Scholar, 14Rigel D.S. Robins P. Friedman R.J. Predicting recurrence of basal cell carcinomas treated by microscopically controlled excision. A recurrence index score.J Dermatol Surg Oncol. 1981; 7: 807-810Google Scholar These publications contain little information on the nature or definition of the local recurrences, however. Specifically, local recurrence is not consistently or uniformly defined, nor are index lesion photographs compared with the appearance of new lesions, nor are initial histological clearance margins around index lesions quantified. The present series represents a minimum 5 years follow up study attempting to identify all patients returning to one surgeon with probable or possible recurrent basal cell carcinoma after conventional surgical excision, relating probability of recurrence to histological clearance measurements and colour photographs. Some of the earlier treated patients (from 1988 onwards) had much longer potential follow up—maximum 15 years and indeed some ‘recurrences’ (two probable and four possible) in this series occurred >5 years. It is recognised that some 18–20% of recurrences will occur beyond 5 years,12Rowe D.E. Comparison of treatment modalities for basal cell carcinoma.Clin Dermatol. 1995; 13: 617-620Google Scholar, 28Hruza G.J. Mohs micrographic surgery local recurrences.J Dermatol Surg Oncol. 1994; 20: 573-577Google Scholar, 29Randle H.W. Basal cell carcinoma. Identification and treatment of the high risk patient.Dermatol Surg. 1996; 22: 255-261Google Scholar but the minimum 5 years follow up chosen here is a useful time scale for comparison between series. An assumption of the study was that recurrences would be referred back to the plastic surgeon" @default.
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• W2040673731 title "Do basal cell carcinomas recur after complete conventional surgical excision?" @default.
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