Real-Life Data on the Management of Incompletely Excised Basal Cell Carcinoma.

BACKGROUND: The histopathologic presence of basal cell carcinoma (BCC) cells at one or more margins of the specimen after surgical excision is considered suggestive of incomplete tumor clearance. The management of incompletely excised BCC might vary in different clinical scenarios from re-excision to application of other treatments or even watchful waiting. OBJECTIVE: The aims of the study were to report the real-life management of incompletely excised BCC in a tertiary referral center and compare the recurrence rates according to the selected management modality. METHODS: A retrospective study was conducted at a tertiary Dermatology Center in Northern Greece. Our electronic database was scanned over a 5-year period to retrieve all BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep). The included patients were divided into 3 groups according to the selected management after incomplete excision: group 1 included those who underwent immediate re-excision (n = 26), group 2 those who were followed up without any additional therapy (n = 40), and group 3 those who were treated with adjuvant/complementary non-surgical treatment (n = 18). Finally, we recorded the presence or absence of residual tumor in the new histopathologic report of those tumors that were selected to be re-excised (group 1). The primary outcome was the appearance of clinical tumor recurrence. RESULTS: Of 1,689 BCCs recorded in our database, 84 met the inclusion criteria and were included in the analysis. Re-excision had been selected in 26 of 84 patients (group 1), watchful waiting in 40 (group 2), and non-surgical treatments in 18 (group 3). The histopathologic reports of the 26 tumors of group 1 that were re-excised revealed residual tumor in 14 (53.8%) cases. Overall, a clinical recurrence occurred in 14 of 84 patients (16.7%) after a mean follow-up of 17 months. The median time to recurrence was 14 months. Of 40 patients without any treatment, recurrence developed in 10 (25%), while only 2 of 18 patients treated with non-surgical treatments recurred (11.1%). CONCLUSIONS: Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients. This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy.

Frequency of post-treatment disease after excisional procedure in stage IA1 squamous cervical carcinoma - a case series.

Early stages of cervical cancer in young women need conservative treatments. Electrosurgical therapies (LLETZ, LEEP, SWETZ, NETZ) have been recommended for these women. However, there are recommendations to perform a second excision when the specimen margins are not free of disease. This can lead to some important complications. This article aims to verify the frequency of residual invasive or microinvasive disease after the excisional procedure in women with IA1CC. Data on women with IA1CC diagnosed between 1990 and 2022, were retrieved from medical records. Post-treatment disease was detected during a second surgical procedure or postoperative follow-up. Among the 69 included women, three (4.3 percent; CI95 percent 0-9.2) had residual microinvasive lesions, while none showed invasive disease during a second procedure or follow-up. Only the age of 37 years or more was significantly related to the presence of preinvasive or microinvasive residual lesions. Nearly 80 percent of the women who underwent a second procedure showed no residual lesions. The absence of invasive disease in a second procedure or during the follow-up of these women and the large proportion of women with no residual lesion questions the need for a new surgical procedure even when the surgical margins of the initial specimen are involved.

Incomplete Excisions of Melanocytic Lesions: Rates and Risk Factors.

Incomplete excisions of melanocytic lesions occur despite the intention of complete removal. The aim of this study was to determine the incomplete excision rates for benign and malignant melanocytic lesions and the associated risk factors. Demographic, clinical, and histo-pathological data possibly associated with incomplete excision were collected from 2,782 consecutive excisions between 2014 and 2015. Of these, 269 melanocytic lesions (9.7%) were incompletely excised. Multivariate analysis revealed the following risk factors for significantly higher incomplete excision rates: lesions located in the head and neck area (odds ratio (OR) 3.95, 95% confidence interval (95% CI) 2.35-6.65), surgery performed by general practitioners (OR 3.01, 95% CI 2.16-4.19), the use of a punch excision technique (OR 2.83, 95% CI 1.96-4.08), and excision of non-dysplastic naevi (OR 1.58, 95% CI 1.11-2.23). In conclusion, more caution should be taken when excising melanocytic lesions in the head and neck area, general practitioners require more surgical training, and punch excisions of melanocytic lesions should be avoided.

Clinicopathological Factors Associated with Incomplete Excision of High-risk Basal Cell Carcinoma.

Research has shown higher rates of incomplete excision among high-risk than low-risk basal cell carcinomas, but data is limited. A single-centre, retrospective study including excised high-risk basal cell carcinomas (type II-III according to the Swedish classification) was performed to determine incomplete excision rates and associated clinicopathological risk factors. Overall, 987 consecutive cases were included. Of these, 203 (20.6%) were incompletely excised. Incomplete excision rates were higher for type III basal cell carcinomas (27.0% vs 17.6% for type II, p < 0.001) and localization on the face and scalp (22.4% vs 14.7% for other locations, p = 0.009), especially on the nose, ear, scalp and periorbital area (28.0-37.0% vs 9.5-16.9% for other locations, p < 0.0001). Circular excisions were also more often incomplete (28.5%) compared with elliptical excisions (17.7%) (p < 0.001). No association was found between incomplete excision rates and tumour size, excision margins, use of a preoperative biopsy or surgeon experience. Mohs micrographic surgery should be used more often for type II-III basal cell carcinomas on the face and scalp.

Mohs Micrographic Surgery for Primary Versus Recurrent or Incompletely Excised Facial High-risk Basal Cell Carcinomas.

Facial high-risk basal cell carcinomas are preferably treated with Mohs micrographic surgery, but only 10% of patients are offered Mohs micrographic surgery in Sweden. The aim of this retrospective study was to examine the differences between primary and recurrent or incompletely excised facial high-risk basal cell carcinomas undergoing Mohs micrographic surgery, with regard to the number of stages, final defect sizes, reconstructive techniques and other consequences. The study was performed during the period 2012 to 2019 at our centre. A total of 903 basal cell carcinomas in 813 patients (70.1% primary, 10.4% incompletely excised and 19.5% recurrences) were included. The mean number of Mohs micrographic surgery stages was significantly lower for primary basal cell carcinomas compared with recurrences (p = 0.03), and the mean final defect size was significantly smaller in primary basal cell carcinomas compared with both recurrent (p < 0.0001) and incompletely excised (p = 0.003) tumours. Primary basal cell carcinomas tended to more often be reconstructed by primary closure (p = 0.08). Mohs micrographic surgery indications for facial high-risk basal cell carcinomas should be respected and used more frequently on primary basal cell carcinomas, in order to enable better utilization of resources and improved outcomes for the patient.

Clinicopathological Factors Associated with Incomplete Excision of Cutaneous Squamous Cell Carcinoma.

Cutaneous squamous cell carcinoma (SCC) is the second most common type of cancer in Swedish men and women. The incidence of SCC is increasing rapidly. Primary treatment is complete surgical excision with sufficient margins to avoid recurrence and metastasis. The aim of this retrospective study was to identify the clinicopathological factors associated with incomplete excision of SCCs. Clinicopathological data and surgical outcome was obtained for 691 SCCs excised during a 2-year period (2014 to 2015) in Gothenberg, Sweden. Overall, 81 SCCs (11.7%) were incompletely excised. Incomplete excisions were associated with physician specialty and experience, tumour localization in the head and neck region, larger tumour diameter, and lower grade of tumour differentiation. However, multiple regression analysis revealed that large tumour size and excisions carried out by general practitioners were the only factors that significantly negatively affected rates of incomplete excision. These results should be taken into consideration when excising SCCs, in order to avoid multiple excisions.

Periocular basal cell carcinoma: recurrence risk factors/when to reoperate?

INTRODUCTION: The aim of periocular basal cell carcinoma (BCC) surgery is radical excision of the tumour while maintaining eyelid functionality and facial aesthetics. Differences in management of the patients after excision of eyelid BCC with a narrow margin are described in the literature. AIM: This study concerns the correlation between the recurrence rate in the periorbital area and the narrow safety margin of excision in the histopathological report with respect to various clinical and histopathological features. MATERIAL AND METHODS: A retrospective non-randomized analysis was conducted on 158 patients with BCC of the periorbital area. These patients were operated on between January 2002 and December 2016. A database was created, comprised of patient age, sex, location of the lesion, TNM, method of reconstruction, result of the histopathological examination, date and location of the recurrence. RESULTS: In 66 (41.77%) patients BCC was radically removed. In 50 (31.65%) patients BCC was removed with a narrow margin and in 42 (26.58%) cases, radical excision was not achieved. The recurrence rate was significantly higher in the aggressive BCC group compared to those with non-aggressive BCC (p = 0.004). The recurrence-free rate for non-aggressive subtypes was 98.11% in both the first and fifth years, but in aggressive subtypes it was 89.06% in the first year but fell to 80.16% in the fifth year. CONCLUSIONS: An aggressive subtype of BCC significantly influences the risk of non-radical excision of the lesion. Aggressive BCC subtypes should have more frequent check-ups. There is no need to reoperate patients with a narrow margin of BCC excision.

Patients prioritize local recurrence risk over other attributes for surgical treatment of facial melanomas-Results of a stated preference survey and choice-based conjoint analysis.

BACKGROUND: Surgical treatment options for facial melanomas include conventional excision with postoperative margin assessment, Mohs micrographic surgery (MMS) with immunostains (MMS-I), and slow MMS. Patient preferences for these surgical options have not been studied. OBJECTIVES: To evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes. METHODS: Participants completed a 2-part study consisting of a stated preference survey and a choice-based conjoint analysis experiment. RESULTS: Patients overwhelmingly (94.3%) rated local recurrence risk as very important and ranked it as the most important attribute of surgical treatment for facial melanoma. Via choice-based conjoint analysis, patients ranked the following surgical attributes from highest to lowest in importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, more than 73% of respondents selected MMS-I or slow MMS as their preferred treatment option for a facial melanoma. LIMITATIONS: Data were obtained from a single health system. CONCLUSION: Patients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.

Risk factors for positive or equivocal margins after wide local excision of 1345 cutaneous melanomas.

BACKGROUND: Positive or equivocal margins after wide local excision (WLE) complicate surgical management of cutaneous melanoma. OBJECTIVE: To identify the frequency of and risk factors for positive or equivocal margins after WLE of cutaneous melanoma. METHODS: Retrospective, single-center, cross-sectional study of 1345 consecutive melanomas treated with WLE. RESULTS: The overall frequency of positive or equivocal margins was 4.2% (56/1345), ranging from 2.2% to 22.6%, depending on the size of the surgical margins, patient characteristics, biopsy history, and the clinicopathology of the melanoma. In descending order, independent risk factors associated with the greatest odds for positive or equivocal margins after multivariate analysis were noncompliance with recommended surgical margins (odds ratio [OR] 5.57, P = .002); anatomic location on the head, neck, hands, feet, genitals, or pretibial leg (OR 5.07, P < .001); histologic regression (OR 2.78, P = .007); in situ melanoma (OR 2.27, P = .011); multiple biopsies at the tumor site before WLE (OR 1.92 [per biopsy], P = .004); and increasing age (OR 1.049 [per year], P < .001). LIMITATIONS: This was a single-site, retrospective observational study. CONCLUSIONS: Clinicopathologic factors, especially location in cosmetically or functionally sensitive areas and noncompliance with recommended surgical margins, identified melanomas at increased risk for positive or equivocal margins after WLE.

Incomplete excision of basal cell carcinoma (BCC) in the head and neck region: to wait, or not to wait?

INTRODUCTION: Recurrence rates for incompletely excised basal cell carcinoma (BCC) vary widely in the literature. Clinical observation is a commonly accepted method of follow up, however such management of these lesions still remains controversial. AIM: To evaluate the rate and factors associated with the recurrence of BCC of the head and neck region after incomplete excision. MATERIAL AND METHODS: Medical records of 135 patients with 156 incompletely excised BCCs of the head and neck region were analyzed retrospectively. The primary outcome was the rate of recurrence. Additionally, a correlation of recurrence to clinical and morphological factors was analyzed. RESULTS: Recurrence occurred in 72 (46%) lesions. The mean interval to recurrence was 20 months. In each category of factors, the highest relative risk of recurrence was correlated to: location on the scalp - 2.27, diameter over 2 cm - 1.21, nodular clinical form - 1.29, morpheaform histopathological type - 1.67, recurrent lesion - 1.88, irradicality of excision in the lateral margin - 1.24 and closure of the skin defect with the split-thickness skin graft - 1.42 relative risk. CONCLUSIONS: Observation is an acceptable management option as less than a half of incompletely excised BCCs recurred and needed further treatment. As 85% of recurrences occur within 3 years after operation, clinical observation should be particularly careful during this period, however long-term recurrence should not be underestimated.

Nasal basal cell carcinomas. Can we reduce surgical margins to 3mm with complete excision?

BACKGROUND: The purpose of this study was to evaluate the incomplete excision rate of nasal basal cell carcinomas (BCC) resected with different margins to demonstrate that 3-mm surgical margins could be used as safety margins to reduce esthetic consequences with a low risk of incomplete excision. METHODS: All patients with BCC of the nose excised from January 1st 2008 to December 31st 2011 were included. Data were analyzed and reviewed retrospectively. Tumors were treated with different surgical margins of excision: 3mm, 4mm, and 5mm. The primary outcome variable was the rate of incomplete excision. Other study variables were the histologic subtype, size, and recurrent lesions. RESULTS: Of the 132 patients, 115 were included corresponding on with 127 BCC. Median age was 75.5 (64-83) and sex ratio M:F=1.05. Of the 127 BCC, 80 were aggressive histologic subtype (63%), and 11 were recurrent (8.7%). The overall rate of incomplete excision was 17.3% (n=22). Of these 22, 17 (77.3%) were of an aggressive subtype. The incomplete excision rates within the groups were 12.5% (n=4), 22.2% (n=10), and 16% (n=8), respectively within the group with 3-, 4- and 5-mm surgical margins. No significant difference was observed between the groups (P=.519). The incomplete excision rate was not independently associated with the surgical margins, histologic subtype and recurrent type (P>.05). CONCLUSION: Three-millimeters margins could possibly be used to treat nasal BCC in chosen cases. Regarding the high rate of incomplete excision, reconstruction should be performed after receiving the pathologic report.

Margin status of basal cell carcinoma: What can be done better?

PURPOSE: Guidelines on clinical margins for basal cell carcinoma (BCC) excisions were recently published, yet the ambiguity regarding the margin continues for surgeons and pathologists. The purpose of this study was to determine the incomplete excision rate of BCC, determine the factors associated with incomplete excision, and evaluate the completeness of reporting between surgeon and pathologist. METHODS: A single-center retrospective analysis was conducted on pathology reports from single excisions of BCC specimens between January 1, 2019 to December 31, 2020. The primary outcome was the incomplete excision rate (positive margins) as reported by pathologist. Logistic regression was used to determine the relationship between incomplete excision rate and anatomical location, pathologist, and surgeon. The completeness of surgeon pathology requisition forms was evaluated qualitatively. RESULTS: Seven hundred and fifty-six pathology reports were included. The incomplete excision rate was 12% (n = 94). The most common site of incomplete excision was head and neck (n = 87, 15%), followed by trunk (n = 5, 7%), and extremities (n = 2, 2%). Five hundred and seventy-nine specimens from 6 surgeons and 9 pathologists were included in the logistic regression analysis. The Wald test showed that the location was significantly associated with incomplete excision (p < 0.05), whereas surgeon and pathologist reports were not (p > 0.05). Regarding missing information, only 47 (6%) pathology reports included "excision" in the requisition form. Four hundred and three (53%) specimens had no clinical history. CONCLUSIONS: The incomplete excision rate found in this study falls within the report range in the literature. Neither surgeon nor pathologist had significant association with incomplete excision. Incomplete excision rate of BCC may be inflated owing to the lack of standardization in requisition form and pathology reporting.

Incomplete excisions of extremity soft tissue sarcomas are unaffected by insurance status or distance from a sarcoma center.

BACKGROUND: Soft tissue sarcomas (STS) continue to be excised inappropriately without proper preoperative planning. The reasons for this remain elusive. The role of insurance status and patient distance from sarcoma center in influencing such inappropriate excisions were examined in this study. METHODS: This retrospective review of a single institution prospective database evaluated 400 patients treated for STS of the extremities between January 2000 and December 2008. Two hundred fifty three patients had a primary excision while 147 patients underwent re-excision. Wilcoxon rank sum test and either χ(2) or Fisher's exact were used to compare variables. Multivariable regression analyses were used to take into account potential confounders and identify variables that affected excision status. RESULTS: Tumor size, site, depth, stage, margins, and histology were significantly different between the primary excision and re-excision groups; P < 0.05. Insurance status and patient distance from the treatment center were not statistically different between the two groups. Large and deep tumors and certain histology types predicted appropriate referral. CONCLUSIONS: Inappropriate excision of STS is not influenced by patient distance from a sarcoma center or by a patient's insurance status. In this study, tumor size, depth, and certain histology types predicted the appropriate referral of a STS to a sarcoma center.

Rare recurrence of a multilocular cystic leiomyoma following myomectomy.

Multilocular cystic leiomyomas rarely develop following myomectomy. To the best of our knowledge, there are no published reports on recurrent multilocular cystic leiomyoma following myomectomy. We here present such a case. A 45-year-old woman visited our outpatient clinic because of heavy vaginal bleeding. She underwent laparoscopic myomectomy for a solid mass in the uterine cavity. Subsequent pathological examination of the operative specimen revealed a tumour with well-demarcated borders and spindle cells arranged in intersecting fascicles. Seven days postoperatively, ultrasonography revealed a cystic lesion. Magnetic resonance imaging performed 28 months postoperatively revealed a large, well-defined, multilocular cystic mass that was homogeneously hyperintense on T2-weighted images on the exterior of the uterus. Abdominal hysterectomy was performed. On pathological examination of the operative specimen, she was found to have a leiomyoma with marked cystic degeneration. Incomplete excision of a multilocular cystic leiomyoma may result in recurrence in the form of a large cystic mass. Clinical differentiation between a multilocular cystic leiomyoma and an ovarian tumour may be difficult. Complete resection of a uterine multilocular cystic lesion prevents recurrence.

Surgical excision of non-melanoma skin cancer: no end in site?

Non-melanoma skin cancer (NMSC) is the most common type of cancer in the UK and Ireland, accounting for approximately 20% of all new malignancies recorded, with evidence of increasing incidence. Surgical excision is regarded as the gold standard treatment for such lesions; however, incomplete excision incurs both physical and financial strain on patients and the healthcare service. Our aim is to identify which anatomical regions of the head and neck pose greater risk of incomplete excision and raise awareness for future surgical practice. Manual data collection was carried out on all patients admitted to the OMFS department for surgical excision of NMSCs between January 2016 and December 2017. Information collected included clinical notes and MDT outcomes. NMSCs excised via Mohs surgery. All tumours incompletely excised and requiring further treatment were noted with particular emphasis on the site of the lesion within the head and neck region, and the location of the positive margin on the specimen itself. A total of 506 NMSCs were excised (307 BCC, 199 SCC). Of these, 7.8% (n=24) and 6.0% (n=12), respectively, required further treatment due to incomplete excision. The incompletely exised lesions were predominately located on the nose (13.3%), temple (15.0%), and ear (12.8%). Our results demonstrate that our department is successfully excising NMSCs with minimal cases requiring further management. This study has identified anatomical profiles posing a higher risk of incomplete removal. Alongside the conventionally challenging sites of the nose and ear, we have highlighted additional risk within the temporal region. We therefore propose that Mohs surgery or a two-stage procedure should be considered as management for the temple at future MDTs.

Risk factors for positive margins after wide local excision of cutaneous squamous cell carcinoma.

BACKGROUND AND OBJECTIVES: The standard treatment for cutaneous squamous cell carcinoma (cSCC) is wide local excision (WLE). Incomplete tumor excision is associated with increased recurrence rates and mortality risk. Risk factors for positive margins after WLE of cSCC has been examined in only a few studies. We sought to assess the influence of several clinicopathological factors on margin status in the largest cSCC population to date. METHODS: We performed a retrospective review of records at two skin cancer clinics identifying patients with biopsy-proven cSCC who underwent WLE. We mined clinicopathological information for eligible subjects including age, gender, lesion location, immunosuppression, previous treatment, lesion size, biopsy type, tumor subtype, tumor thickness, degree of differentiation, ulceration and perineural invasion. RESULTS: A total of 1468 patients were eligible and 117 (8%) had positive margins after WLE. Older age at diagnosis (p = .011), lesion location on the head and neck (p < .001), previous treatment (p < .001), increased lesion diameter (p < .001), invasive subtype (p = .020) or increased tumor thickness (p < .001) were statistically significant risk factors for positive surgical margins. CONCLUSIONS: Our results present an opportunity to stratify cSCC patients into low- or high-risk for incomplete tumor clearance after WLE based on several clinicopathological factors. These findings should educate and inform the dermatologic surgeon's choice of primary management of cSCC.

Pre-operative evaluation prior to soft tissue sarcoma excision - Why can't we get it right?

BACKGROUND: To define the association between an appropriate pre-operative workup (pre-operative advanced imaging studies, diagnostic biopsy) and incomplete soft tissue sarcoma (STS) excision. PATIENTS AND METHODS: This was a retrospective review of 397 consecutive patient records (2000-2008), looking at primary site advanced imaging (MRI or CT) and diagnostic biopsy procedures completed prior to the initial attempt at definitive surgical excision. Downstream effects of an inadequate pre-operative workup were also evaluated, including time to referral to a sarcoma multi-disciplinary care team and perceived alteration of surgical care in order to obtain a complete excision of the altered sarcoma bed. RESULTS: Thirty-eight percent (149/397) of soft tissue sarcomas identified underwent an incomplete excision prior to referral. A significant difference in the incidence of pre-operative primary site advanced imaging (91% vs. 42%, p < 0.001) and a pre-operative diagnostic biopsy (85% vs. 16%, p < 0.001) was found between the wide excision group and incomplete excision groups. Pre-operative biopsy (p < 0.001), tumor size >5 cm (p < 0.001), and a referral from an orthopaedic surgeon (p < 0.02) were all associated with reduced risk of incomplete excision in multivariate analysis. Seventy-four percent of patients in the incomplete excision group required an alteration in their definitive wide margin surgical resection, including rotational muscle flap coverage (37%), free flap coverage (11%), or amputation (11%). CONCLUSION: A minority of patients referred following incomplete excision of a STS had undergone an appropriate pre-operative workup prior to referral, leading to increased long-term morbidity following definitive re-excision. Education efforts to heighten awareness of suspicious soft tissue lesions remain vital.

Risk Factors for Incomplete Excision after Loop Electrosurgical Excision Procedure (LEEP) in Abnormal Cervical Cytology

Objective: To investigate the risk factors related to incomplete excision after loop electrosurgical excision procedure (LEEP) in abnormal cervical cytology. Methods: This retrospective cohort study was performed during September 2010 to February 2017. The study population was patients with abnormal cervical cytology who treated by LEEP at Prapokklao hospital, Chanthaburi. From the medical records, data were collected include age, menopausal status, parity, body mass index, HIV infection, history of smoking, cervical cytology and characteristics of LEEP histopathology such as number of specimen, size and glandular involvement. Risk factors were investigated using multivariable risk ratio from risk ratio regression. Result: Five hundred cases of LEEP were done during this period and 322 cases were analyzed. Complete excision of the LEEP specimens found nearly half of the cases (46.9%). Multiple pieces of specimen was the risk factor for incomplete excision of LEEP (adjusted risk ratio [aRR] = 1.29, 95% confidence interval [CI] = 1.06-1.58; P = 0.013). Conclusion: The number of specimen from LEEP more than one piece was the risk factor for incomplete excision. Alternative methods such as cold knife conization (CKC), needle excision of the transformation zone (NETZ) or contoured loop excision of the transformation zone (C-LETZ) should be justified when all lesions could not be operated by single sweep.

Basal cell carcinomata: Risk factors for incomplete excision and results of re-excision.

INTRODUCTION: Re-excision of incompletely excised basal cell carcinomas (BCCs) can be unsatisfactory in the absence of residual tumours. Recommended guidelines do suggest re-excision as a treatment modality; however, its value has been questioned due to low or variable residual tumour presence. We analysed the incomplete excision and re-excision rates and the presence of residual tumours over an 18-month period in a single unit. METHOD: Using pathology results and case notes, 2586 primary excisions of BCCs in 1717 patients were reviewed. RESULTS: The incomplete excision rate was reported to be 7.1% (184/2586). Excision of a lesion by multiple excision lesion procedure was associated with a higher rate of incomplete excision when compared to single lesion excision procedure (61.5% vs. 38.5%). Of the incompletely excised BCCs, 33.6% (62/184) were re-excised, of which 62.9% (39/62) had residual tumours. Although the figures are small, most anatomical sites examined had a residual tumour presence >50%. CONCLUSION: After evaluating each patient individually, considering the high residual tumour rate, re-excision of an incompletely excised BCC would be a worthwhile procedure.

Comparison of complete and incomplete excision of deep infiltrating endometriosis.

OBJECTIVE: To compare the efficacy and safety of complete and incomplete excision of deep infiltrating endometriosis (DIE). METHODS: Ninety-three women who underwent complete excision (n=55) or incomplete surgery of DIE (n=38) between January 2011 and December 2013 were included in this retrospective cohort study. Surgical data, and follow-up information of the patients were analyzed. RESULTS: Eighty-five women (91.4%) returned for their follow-up after the operation. The mean follow-up time was 18.3±8.7 months. The complete excision group had a significantly higher complication rate than the incomplete excision group (9.1% VS 0%, P<0.001). The decrease of visual analog scale (VAS) scores were more significant (5.6±3.9 VS 2.9±3.3, P=0.001), and the postoperative recurrence rate is significantly lower (3.9% VS 35.3%, P=0.000) in the complete excision group than that in the in-complete surgery group. The palliative incomplete excision had a comparable pregnancy rate and comparable quality of life in most aspects, except psychological score. And in the in-complete excision patients, administration of post-operative GnRH agonist had a post-treatment improvement of VAS score similar with the complete excision patient (4.5±3.2 versus 5.6±3.9, P=0.272). However, the recurrence rate were still significantly higher (29.4% VS 3.9%, P=0.000). CONCLUSIONS: Comparing with incomplete excision, the complete excision of DIE significantly decreased the post-operative pain and the recurrence rate. Although incomplete excision with post-operative GnRHa is efficient with respect to pain, the side effects of the drugs and the recurrence rate after cessation of the drugs must be considered. So complete excision of DIE is the first surgical treatment of choice.