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Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma?: A Prospective Clinical Study

Hoefkens, Mirjam F. MD*†; Fabré, Jan MD*; Küsters-Vandevelde, Heidi V.N. MD

doi: 10.1097/SAP.0b013e31826524df
Reconstructive Surgery

Objectives Incomplete excision of a basal cell carcinoma (BCC) remains a frustrating problem. Various attempts have been made to decrease the rate of incomplete excisions, including the use of loupe magnification.

Method A prospective, controlled study is presented, which was designed to evaluate whether loupe magnification (×3.5) leads to a more accurate determination of the clinical border of primary facial BCCs. The objectives of this study were 4-fold: to analyze if there was a statistically significant difference when using a loupe magnifier or not in (1) rate of incomplete excisions, (2) width of histologic margins, (3) excised surface areas, and (4) types of closure.

Results Ninety primary facial BCCs in 81 patients were treated by conventional surgical excision. Forty-five BCCs (40 patients) were excised with loupe magnification, and 45 (41 patients), without. Although the number of incomplete excisions was equal in both groups (n = 3), the mean histologic margin was larger in the study group (2.4 mm) compared with the control group (2.1 mm). This could illustrate the enhanced visualization by using a magnifier, which consequently results in excising a lesion with excessive unaffected skin, after adding a standard surgical margin. Furthermore, the mean surface area of BCCs was larger in the study group (103.7 mm2) compared with that in the control group (76.1 mm2). More defects were closed in a nonprimary fashion in the study group (n = 14) compared with the control group (n = 10). However, none of these differences did reach statistical significance.

Conclusion Our results could implicate that the determination of the surgical margin might be influenced not only by size, location, and histologic subtype of the tumor but also by the method of tumor assessment. This means that deciding on the appropriate surgical margin might be adapted according to the method of preoperative evaluation of tumor extensions.

From the *Department of Plastic and Reconstructive Surgery, Canisius Wilhelmina Hospital; †Department of Plastic and Reconstructive Surgery, Radboud University Medical Center; and ‡Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.

Received May 14, 2012, and accepted for publication, after revision, June 18, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Mirjam F. Hoefkens, MD, 169 De Lairesselaan, 3062 PH Rotterdam, The Netherlands. E-mail:

© 2014 by Lippincott Williams & Wilkins