Basal Cell Carcinoma. Analysis of 395 cases localized in the neck, ear and nose region

Abstract

BACKGROUND AND OBJECTIVES: To test if there are different outcomes in basal cell carcinoma for lesion size, histopathology, localization, and recurrence rates. MATERIALS AND METHODS: A total of 395 patients with BCC localized in the neck, nose and ear regions who were surgically treated in Latvian Oncology Centre between 2006-2011 were analyzed retrospectively. The data were analyzed using modified classification based on Clarks et al. (2014) and McKenzie et al. (2016). RESULTS: Three hundred and ninety-five cases of BCC that were surgically treated in head and neck region were reviewed. Results were tabulated in four categories: anatomical region, histopathology, lesion size, and recurrence rates. Classification by anatomical region: 228 cases in the nose region, 82 cases in the neck region, 82 cases in the ear region. Classification by histopathology: 259 cases presented as low risk BCC [nodular, pigmented, adenoid, keratotic and cystic], 21 cases presented as superficial, 94 cases presented as mixed, and 21 cases presented as high-risk BCC (metatypical, morphea form). Mann-Whitney U test was used to compare recurrent BCC cases to non-recurrent cases. Significantly higher recurrence rates were observed if BCC at the time of the excision was ≥10 mm (p<0.001). Significance was also noted in cases where histopathology was mixed BCC and in cases where mixed BCC was localized to the nose region (p<0.001). CONCLUSION: More attention should be brought to assessing classification and clinical treatment synergy. Higher recurrence rates are observed when lesions occur in high risk anatomical region (H zone), when lesion size reaches or exceeds 20 mm in diameter, and when lesion is subtyped as mixed BCC. It is crucial to evaluate risk factors such as BCC subtype and localization, as these are associated with a higher rate of recurrence when present in a single lesion. These risk factors, together with pre-treatment lesion evaluation will enable formulation of better treatment plan and prognostic aspects in each case.