BASAL CELL CARCINOMA EXCISION INTRAOPERATIVE FROZEN SECTION FOR TUMOUR CLEARANCE AND RECONSTRUCTIVE SURGERY
DOI:
https://doi.org/10.55519/JAMC-04-13800Keywords:
BCC frozen section, BCC face reconstruction technique and tumor free margin, Tumor free margin, BCC excisionAbstract
Background: Basal cell carcinoma (BCC) is the most common skin cancer. The majority of BCC are in Europe, US and Australia. Annual incidence in US is 2 million per year with an increase of 0.87% 1. Sun exposure to face, ears, neck, back, shoulders and hands are attributable factors Objective was to report intraoperative frozen section clearance rate of tumour margins and depth for excised basal cell carcinoma in a tertiary care center and find the frequency of tumour involved surgical margins concerning the anatomical site, size, and surgical technique. Method; It was a prospective open-label interventional study conducted at the Dermatology department of tertiary care hospital Rawalpindi (Pakistan) in liaison with the histopathology department from January 2023 to April 2024. Patients aged from 45–80 years, with a clinical diagnosis of basal cell carcinoma, having a size of 10–35 mm located on the face were included as per inclusion/ exclusion criteria. A surgical excision was performed under local anaesthesia at the dermatology department. An intraoperative frozen section for tumour margins and depth was taken from a histopathologist. The surgical defect was reconstructed on the same day after the negative report. p-value of <0.05 was considered significant for margin involvement, surgical technique, and anatomical site. Results; A Total of 36 patients of BCC were enrolled. There were 12 (33.3%) males and 24 (66.6%) females. The size of BCC ranged from 10–35 mm mean of 25 mm ±SD 0.63. Tumour-free margins and depth were attained in 77.77% of cases. Tumour excision with a frozen section concerning surgical technique had a chi-square p-value ≤0.51, for anatomical site chi-square p-value ≤0.24, and for size was p-value ≤0.84. Conclusion: Intraoperative frozen section for basal cell carcinoma is a reliable technique for complete tumour excision in our center with 77.7% margin clearance. This technique is resource-intensive and time-consuming. Patients achieve complete excision and better aesthetic outcomes. Patients following surgical excision of basal cell carcinoma on the face with intraoperative frozen section are benefited through preservation of form and function. The intraoperative frozen section is available in tertiary care hospitals in Pakistan. It is resource-intensive for patients living in remote areas. Intraoperative frozen section is recommended for patients where tumour is located at high-risk sites and requires complex reconstruction after tumour excision. Patients should be educated for follow-up visits in case of induration, morphological changes, or new developments in scar which may require re-excision
References
1. Shaikh WR, Nawas ZY. Epidemiology and Risk Factors of Basal Cell Carcinoma; Adv Treat Res 2020;2020:1-8.
2. Tsai, J., & Chien, A. L. Photoprotection for Skin of Color. Am J Clin. Dermatol.2022; 23(2);195–205. https://doi.org/10.1007/s40257-021-00670-z
3. Muzic JG, Schmitt AR, Wright AC, Alniemi DT, Zubair AS, Olazagasti Lourido JM, et al. Incidence and Trends of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma: A Population-Based Study in Olmsted County, Minnesota. 2000 to 2010”, Mayo Clin Proc 2017;92(6):890–8.
4. Ahmad Z, Idress R, Fatima S, Uddin N, Ahmed A, Minhas K, et al. Commonest cancers in Pakistan - Findings and Histo-pathological Perspective from a Premier Surgical Pathology Center in Pakistan. Asian Pac J Cancer Prev 2016;17(3);1061–75.
5. Sarfraz T, Tariq H, Iftikhar N, Raza N, Malik NA, Khan SA, et al. Frequency and histological pattern of malignant skin le-sions in Pakistani populationPak Armed Forces Med J 2019;69(1):83–6.
6. Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of Care for the Management of Basal Cell Car-cinoma. J Am Acad Dermatol 2018;78(3);540–59.
7. Dika E, Scarfì F, Ferracin M, Broseghini E, Marcelli E, Bortolani B, et al. Basal Cell Carcinoma; A Comprehensive Review. Int J Mol Sci 2020;21(15):5572.
8. Quazi S, Aslam N, Saleem H, Rahman J, Khan S. Surgical Margin of Excision in Basal Cell Carcinoma: A Systematic Review of Literature. Cureus 2018;12(7):e9211.
9. Davitia M, Lallasb K, Dimitriadisa C, Moutsoudisa A, Eleftheriadisa V, Eftychidoua P, et al. Real-Life Data on the Management of Incompletely Excised Basal Cell Carcinoma. Dermatology 2023;239(3):429–35.
10. Hunt WTN, Nelson TG. An International Survey Characteriz-ing Mohs Tissue Processing Techniques and Mohs Margin Thresholds: How close is too close? Clin Exp Dermatol 2022;47(8):1472–9.
11. Bittner GC, Cerci FB, Kubo EM, Tolkachjov SN. Mohs Mi-crographic Surgery: A Review of Indications, Technique, Outcomes and Considerations. An Bras Dermatol 2021;96(3):263–77.
12. Rehman SH, Majid B, Syed SA, Qureshi MA. “Quantitative Analyses of Skin Cancer Research in Pakistan”. Pak J Med Sci 2021;37(2):582–7.
13. Kumar S, Mahajan BB, Kaur S, Yadav A, Singh N, Singh A. A study of Basal Cell Carcinoma in South Asians for Risk Fac-tor and Clinicopathological Characterization: A Hospital Based Study. J Skin Cancer 2014;2014:173582.
14. Tufail M, Wu C. Cancer statistics in Pakistan from 1994 to 2021; Data from Cancer Registry. JCO Clin Cancer Inform 2023;7:e2200142.
15. Cerci FB, Kubo EM, Werner B, Tolkachjov SN. Surgical Margins required for Basal Cell carcinoma treated with Mohs Micrographic Surgery according to Tumour Features. J Am Acad Dermatol 2020;83(2):493–9.
16. Tariq S, Saeed A, Ismaeel H, Ullah S, Hamid MA. Rise in the Number of Complex Skin Cancers Necessitates Establishing Mohs Micrographic Surgery Fellowships in Pakistan. Cureus 2023;15(8):e43183.
17. van Loo E, Mosterd K, Krekels GA, Roozeboom MH, Oster-tag JU, Dirksen CD, et al. Surgical excision versus Mohs’ Micrographic Surgery for Basal Cell Carcinoma of the Face: A Randomised Clinical Trial with 10 Year Follow-up. Eur J Cancer 2014;50(17):3011–20.
18. Tanese K. Diagnosis and Management of Basal Cell Carci-noma. Curr Treat Options Oncol 2019;20(2):13.
19. Asif M, Mamoon N, Ali Z, Akhtar F. Epidemiological and Excision Margin Status of Basal Cell Carcinoma - Three Years in Armed Forces Institute of Pathology experience in Pakistan. Asian Pac J Cancer Prev 2010;11(5):1421–3.
20. Ullah H, Tahir M, Khan M, Naz S. Frequency of Incomplete Excision of Low Risk Facial Basal Cell Carcinoma with a Safety Margin of Three Millimeter. Pak J Surg 2018;34(1):72–7.
21. Ul Kadir SM, Rani Mitra M, Rashid R, Nuruddin M, Hassan Khan MK, Haider G, et al. Clinicopathological Analysis and Surgical Outcome of Eyelid Malignancies: A Study of 332 Cases. J Skin Cancer 2022;2022:4075668.
22. Bahat AA, Sari M, Listiawan MY, Putra ND, Thendria T, Kurniasari FT, et al. The Role of Nicotamide as Chemopro-phylaxis in Basal Cell Carcinoma: A Literature Review. J Pak Assoc Dermatol 2023;33(4):1669–76.
23. Weshah S, Smadi R, Helalat M. Basal Cell Carcinoma: A Retrospective Analysis of 76 Patients. Pak J Med Sci 2007;23(4):556–60.
24. Anandani A, Ganatra MA. Incidence of Basal Cell Carcino-ma at Plastic Surgery Department of Tertiary Care Hospital in Karachi. J Surg Pak 2011;27(2):117–20.
25. Jaffar N, Kehar SI, Iqbal J, Ghani R, Hasan SM. Morphologi-cal Spectrum of Non-Melanoma Skin Cancer Experience at Tertiary Care Hospital in Karachi, Pakistan. Pak J Med Dent 2019;8(1):7.
26. Afridi RAK, Ahmed E, Khan SA, Ali A. Demographics Of Basal Cell Carcinoma and its Surgical Management. J Ayub Med Coll Abbottabad 2012;24(3-4):141–3.
27. Ito T, Inatomi Y, Nagae K, Nakamura MN, Nakahara T, Furue M, et al. Narrow‐margin excision is a safe, reliable treatment for well‐defined, primary pigmented basal cell carcinoma: an analysis of 288 lesions in Japan. J Eur Acad Dermatol Vene-reol 2015;29(9):1828–31.
28. Otsuka ACVG, Bertolli E, de Macedo MP, Pinto CAL, Duprat Neto JP. Intraoperative Assessment of Surgical Margins Us-ing ‘en face’ Frozen Sections in the Management of Cutane-ous Carcinomas. An Bras Dermatol 2022;97(5):583–91.
29. Babar A, Jamal S, Ali SS, Anjum S, Rizvi DA. “Success of Surgical Treatment of Basal Cell Carcinoma; Role of In-traoperative Frozen Section”. Pak Armed Forces Med J 2018;68(6):1556–60.
30. Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, et al. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023;21(11):1181–1203.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Moizza Tahir, Uzma Bashir, Aisha Akhtar, Sidiqua Javaid, Zainab Ansari, Sameen Ansari
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
