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What Is the Best Surgical Margin for a Basal Cell Carcinoma: A Meta-Analysis of the Literature

Gulleth, Yusuf M.D.; Goldberg, Nelson M.D.; Silverman, Ronald P. M.D.; Gastman, Brian R. M.D.

Plastic and Reconstructive Surgery: October 2010 - Volume 126 - Issue 4 - p 1222-1231
doi: 10.1097/PRS.0b013e3181ea450d
Reconstructive: Head and Neck: Original Articles

Background: Current management of basal cell carcinoma is surgical excision. Most resections use predetermined surgical margins. The basis of ideal resection margins is almost completely from retrospective data and mainly from small case series. This article presents a systematic analysis from a large pool of data to provide a better basis of determining ideal surgical margin.

Methods: A systematic analysis was performed on data from 89 articles from a larger group of 973 articles selected from the PubMed database. Relevant inclusion and exclusion criteria were applied to all articles reviewed and the data were entered into a database for statistical analysis.

Results: The total number of lesions analyzed was 16,066; size ranged from 3 to 30 mm (mean, 11.7 ± 5.9 mm). Surgical margins ranged from 1 to 10 mm (mean, 3.9 ± 1.4 mm). Negative surgical margins ranged 45 to 100 percent (mean, 86 ± 12 percent). Recurrence rates for 5-, 4-, 3-, and 2-mm surgical margins were 0.39, 1.62, 2.56, and 3.96 percent, respectively. Pooled data for incompletely excised margins have an average recurrence rate of 27 percent.

Conclusions: A 3-mm surgical margin can be safely used for nonmorpheaform basal cell carcinoma to attain 95 percent cure rates for lesions 2 cm or smaller. A positive pathologic margin has an average recurrence rate of 27 percent.

Baltimore, Md.

From the Department of Otorhinolaryngology and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine.

Received for publication November 20, 2009; accepted April 9, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Brian R. Gastman, M.D., Department of Surgery; Division of Plastic and Reconstructive Surgery; University of Maryland School of Medicine; 22 South Greene Street; Baltimore, Md. 21201; bgastman@smail.umaryland.edu

©2010American Society of Plastic Surgeons