Basal cell carcinoma of the head and neck – a retrospective outcome analysis following R0/R1 resection.

Guidelines for basal cell carcinoma (BCC) treatment postulate the complete surgical excision as the goldstandard. Due to the tumour’s individual characteristics (localization, histology, size) the postoperative aesthetic result depends on the surgical defect size. A R1-status is defined histopathological if the safety margin is beneath 1 mm even if there are no tumour cells actually infiltrate the resection margin. Therefore a watch-and-wait-strategy in R1 situations already favoured in some studies. We aimed to evaluate the outcome and recurrence rate of resected BCC in the head and neck, especially in a histological proven R1 situation. The outcomes of all resected BCC, observed during a 4-year period (January 2009 – December 2013) were analysed. Our standard operating procedure is a 2-staged surgical excision with a temporary closure and, depending on the histological result, a definitive closure or a re-resection. 298 skin tumours have been resected, 191 of them where BCCs. In 46 (24.1%) cases an R1-status was accepted as a final result in cases of surgical clear margins followed by a close follow-up. In the follow-up (median 2.4 years) we observed local recurrences in 2 patients (4.4%) in this group. No recurrence was observed in the R0-resected group (p=0.057). R1-resected group did show a low, non-significant higher recurrence rate then the R0-resectet group. In contrast to most of the literature the results show, that even without re-resection most of the patients with residual tumour cells won’t suffer from a recurrence in a 5 year follow up. We think that in cases where a frequent follow up can be secured and the surgical area is delicate, a surgical closure in R1 can be justified.