Original Article

Incidence of Incomplete Excision in Surgically Treated Cutaneous Squamous Cell Carcinoma and Identification of the Related Risk Factors

Abstract

Squamous cell carcinoma (SCC) is the second most common type of skin cancer with potential risks for metastasis and recurrence if left untreated or incompletely excised. This case series study was designed to determine the frequency of incompletely excised SCCs and the related risk factors. A total of 273 SCCs (253 patients) excised in Razi dermatology hospital of Tehran from 2006-2008, were evaluated and were analyzed by Chi-square or t-test. The incidence of incomplete excision was 17.58 % and deep margin involvement was observed in 73% of lesions. Risk factors associated with incomplete excision of SCCs were being female, location of the tumors (in particular the lesions on lateral canthus, upper lip, foot, forehead, cheek, neck, nose and ear), large lesions and grafting method of repair. There was no statistically significant difference for the age, degree of histological differentiation, childhood history of radiotherapy for tinea capitis and the type of anesthesia. More care should be taken for high risk SCCs as complete excision avoids potential risk of recurrence and metastasis.

Tan PY, Ek E, Su S, Giorlando F, Dieu T. Incomplete excision of squamous cell carcinoma of the skin: a prospective observational study. Plast Reconstr Surg 2007;120(4):910-6.

Bogdanov-Berezovsky A, Cohen AD, Glesinger R, Cagnano E, Rosenberg L. Risk factors for incomplete excision of squamous cell carcinomas. J Dermatolog Treat 2005;16(5-6):341-4.

Ang P, Tan AW, Goh CL. Comparison of completely versus incompletely excised cutaneous squamous cell carcinomas. Ann Acad Med Singapore 2004;33(1):68-70.

Talbot S, Hitchcock B. Incomplete primary excision of cutaneous basal and squamous cell carcinomas in the Bay of Plenty. N Z Med J 2004;117(1192):U848.

Chiller K, Passaro D, McCalmont T, Vin-Christian K. Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer. Arch Dermatol 2000;136(11):1327-32.

Thomas DJ, King AR, Peat BG. Excision margins for nonmelanotic skin cancer. Plast Reconstr Surg 2003;112(1):57-63.

Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed. Oxford, UK: Wiley- Blackwell; 2008. p. 52.

Huang CC, Boyce SM. Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma. Semin Cutan Med Surg 2004;23(3):167-73.

Johnson TM, Rowe DE, Nelson BR, Swanson NA. Squamous cell carcinoma of the skin (excluding lip and oral mucosa). J Am Acad Dermatol 1992;26(3 Pt 2):467-84.

Dinehart SM, Pollack SV. Metastases from squamous cell carcinoma of the skin and lip. An analysis of twenty-seven cases. J Am Acad Dermatol 1989;21(2 Pt 1):241-8.

Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip.Implications for treatment modality selection. J Am Acad Dermatol 1992;26(6):976-90.

Brodland DG, Zitelli JA. Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol 1992;27(2 Pt 1):241-8.

Kraus DH, Carew JF, Harrison LB. Regional lymph node metastasis from cutaneous squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1998;124(5):582-7.

Friedman HI, Cooper PH, Wanebo HJ. Prognostic and therapeutic use of microstaging of cutaneous squamous cell carcinoma of the trunk and extremities. Cancer 1985;56(5):1099-105.

Petter G, Haustein UF. Histologic subtyping and malignancy assessment of cutaneous squamous cell carcinoma. Dermatol Surg 2000;26(6):521-30.

Cherpelis BS, Marcusen C, Lang PG. Prognostic factors for metastasis in squamous cell carcinoma of the skin. Dermatol Surg 2002;28(3):268-73.

Lichter MD, Karagas MR, Mott LA, Spencer SK, Stukel TA, Greenberg ER. Therapeutic ionizing radiation and the

incidence of basal cell carcinoma and squamous cell carcinoma. The New Hampshire Skin Cancer Study Group. Arch Dermatol 2000;136(8):1007-11.

Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med 2001;344(13):975-83.

Dieu T, Macleod AM. Incomplete excision of basal cell carcinomas: a retrospective audit. ANZ J Surg 2002;72(3):219-21.

Miller SJ. The National Comprehensive Cancer Network (NCCN) guidelines of care for nonmelanoma skin cancers. Dermatol Surg 2000;26(3):289-92.

Reid B. Reducing the incomplete excision of non melanotic skin cancers in Australian general practice. Aust Fam Physician 2000;29(3):278-81.

Files
IssueVol 49, No 12 (2011) QRcode
SectionOriginal Article(s)
Keywords
Cutaneous squamous cell carcinoma Incomplete excision

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How to Cite
1.
Mirshams M, Razzaghi M, Noormohammadpour P, Naraghi Z, Kamyab K, Sabouri Rad S. Incidence of Incomplete Excision in Surgically Treated Cutaneous Squamous Cell Carcinoma and Identification of the Related Risk Factors. Acta Med Iran. 1;49(12):806-809.