Surgical management of Basal cell carcinomas (BCC) of the Head and Neck

Saleh A. Tawfique

Kurdistan Board for Medical specialties, Erbil, Iraq  

Ninety six consecutive cases of BCC of the face and head and neck were managed
during 8 years. 51 patients were female and the rest were male. The average age of
presentation was 64Years. The size of majority of lesions (85%) were less than 10mm.
Lesions appeared mainly on mid face around the nose, inner canthus and forehead. 10.5%
had multiple lesions on presentation. All lesions were managed surgically by total excision
of the lesions with 5mm free healthy skin margin and the defect reconstructed
simultaneously by various types of local or distant skin flaps. The effectiveness of this
procedure was 94% cure rate. The average follow up was 2 years (9-36 months). Ten
patients(10.4%) required second surgical resection as they developed recurrence at the
site of primary resection. Eleven patients (11.4%) showed another lesion on the face
during follow up period. Surgical resection and primary reconstruction of BCCs of the
head and neck are highly recommended and give good success and high percentage
(around 94%) of cure rate. Long term follow up is recommended as new lesions or
recurrence may appear years after management.

Keywords: BCC, skin cancer, surgical management / Abbreviations: BCC = Basal cell
carcinoma. L A= local anesthesia. G A = general anesthesia. EDC = electrodessication and Curettage.

1- Akinci M, Aslan S, Markoc F, Cetin B, Cetin A. Metastatic basal cell carcinoma. Acta Chir Belg. Mar-Apr 108(2):269-72.(2008)
2- Vu A, Laub D Jr; Metastatic Basal cell carcinoma: a case report and review of the literature. Eplasty. Apr 29;11:ic8.(2011)
3- Wong CS, Strange RC, Lear JT "Basal cell carcinoma". BMJ 327 (7418): 794–8. (October 2003).
4- James, William D.; Berger, Timothy G.; et al. Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. (2006).
5- JL, Stern RS. High levels of ultraviolet B exposure increase the risk of nonmelanoma skin cancer in psoralen and ultraviolet A-treated patients. J Invest Dermatol. Mar ;124(3):505-13. (2005)
6- Hoban PR, Lear JT, Strange RC. Basal cell carcinoma: genetic homogeneity in a tumour type displaying phenotypic diversity. Eur J Hum Genet. Sep 14(9):977- 8.(2006)
7- Erba P, Farhadi J, Wettstein R, Arnold A, Harr T, Pierer G. Morphoeic basal cell carcinoma of the face. Scand J Plast Reconstr Surg Hand Surg. 41(4):184-8. (2007) 8- Skin Cancer Foundation. Basal Call Carcinoma: The Most Common Skin Cancer.
Available at Accessed April 23, 2011.
9- Drake LA, Ceilley RI, Cornelison RL, Dobes WA, Dorner W, Goltz RW, et al. Guidelines of care for basal cell carcinoma. The American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol. Jan 26(1):117-20. (1992)
10- Scalvenzi M, Lembo S, Francia MG, Balato A "Dermoscopic patterns of superficial basal cell carcinoma". Int. J. Dermatol. 47 (10): 1015–8. (October 2008).
11- Farhi D, Dupin N, Palangié A, Carlotti A, Avril MF (October 2007). "Incomplete excision of basal cell carcinoma: rate and associated factors among 362 consecutive National Cancer Institute. Physician Data Query (PDQ). Skin
Cancer Treatment. 2010. Accessed at on April 13, (2011).
12- Nagore E, Grau C, Molinero J, Fortea JM "Positive margins in basal cell carcinoma: relationship to clinical features and recurrence risk. A retrospective study of 248 patients". J Eur Acad Dermatol Venereol 17 (2): 167–70. (March 2003).
13- Wolf DJ, Zitelli JA "Surgical margins for basal cell carcinoma". Arch Dermatol 123 (3): 340–4. (March 1987).
14- Griffiths RW, Suvarna SK, Stone J "Basal cell carcinoma histological clearance margins: an analysis of 1539 conventionally excised tumours. Wider still and deeper?". J Plast Reconstr Aesthet Surg 60 (1): 41–7. (2007).
15- Sigurdsson H, Agnarsson BA "Basal cell carcinoma of the eyelid. Risk of recurrence according to adequacy of surgical margins". Acta Ophthalmol Scand 76 (4): 477–80. (August 1998).
16- Hauben DJ, Zirkin H, Mahler D, Sacks M "The biologic behavior of basal cell carcinoma: analysis of recurrence in excised basal cell carcinoma: Part II". Plast. Reconstr. Surg. 69 (1): 110–6. (January 1982).
17- Bentkover SH, Grande DM, Soto H, Kozlicak BA, Guillaume D, Girouard S "Excision of head and neck basal cell carcinoma with a rapid, cross-sectional, frozen-section technique". Arch Facial Plast Surg 4 (2): 114–9. (2002).
18-Raasch B, Woolley T. Management of primary superficial basal cell carcinoma. Aust Fam Physician. Jun ;35(6):455-8. (2006)
19- Barry J, Oon SF, Watson R, Barnes L. The management of basal cell-carcinomas. Ir Med J. Jun 99(6):179-81. (2006)
20- Dandurand M, Petit T, Martel P, Guillot B,. Management of basal cell carcinoma in adults Clinical practice guidelines. Eur J Dermatol. JulAug 16(4):394-401. (2006)
21- National Comprehensive Cancer Network (NCCN). Practice Guidelines inOncology: Basal Cell and Squamous Cell Skin Cancers. Version 1.2011. Accessed at on April 13, (2011).
22- Orengo IF, Salasche SJ, Fewkes J, Khan J, Thornby J, Rubin F. Correlation of histologic subtypes of primary basal cell carcinoma and number of Mohs stages required to achieve a tumor-free plane. J Am Acad Dermatol. Sep 37(3 Pt 1):395-7. (1997)
23- Mosterd K, Krekels GA, Nieman FH, et al. "Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up". Lancet Oncol. 9 (12): 1149–56.. (December 2008).
24- Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. Oct 57(4):616-21. (2007).
25- Glass LF, Fenske NA, Jaroszeski M, et al. Bleomycin-mediated electrochemotherapy of basal cell carcinoma. J Am Acad Dermatol. Jan 34(1):82-6. (1996).
26- Mendenhall WM, Amdur RJ, Hinerman RW, Cognetta AB, Mendenhall NP. Radiotherapy for cutaneous squamous and basal cell carcinomas of the head and neck. Laryngoscope. Oct 119(10):1994-9.(2009).
27- Zimmermann A, Walt H, Haller U, Baas P, Klein SD. Effects of chlorinmediated photodynamic therapy combined with fluoropyrimidines in vitro and in a patient. Cancer Chemother Pharmacol. Feb 51(2):147-54.(2003).
28- Kokoszka A, Scheinfeld N. Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma. Dermatol Surg. 29: 566-71.(2003).
29- Kaur S, Thami GP, Kanwar AJ. Basal cell carcinoma--treatment with cryosurgery. Indian J Dermatol Venereol Leprol. Mar-Apr 69(2):188-90.(2003).
30- Barlow JO, Zalla MJ, Kyle A, DiCaudo DJ, Lim KK, Yiannias JA "Treatment of basal cell carcinoma with curettage alone". J. Am. Acad. Dermatol. 54 (6): 1039–45 (June 2006).
31-Barlow JO, Zalla MJ, Kyle A, DiCaudo DJ, Lim KK, Yiannias JA. Treatment ofbasal cell carcinoma with curettage alone. J Am Acad Dermatol. Jun 54(6):1039-45. (2006)
32- American Academy of Pediatrics. Policy statement – Ultraviolet radiation: A hazard to children and adolescents. Pediatrics. 127:588–597.(2011).
33- American Cancer Society. Facts & Figures 2011. American Cancer Society. Atlanta, Ga. (2011).
34- Mohanty P, Mohanty L, Devi BP. Multiple cutaneous malignancies in xeroderma pigmentosum. Indian J Dermatol Venereol Leprol. Mar-Apr 67(2):96- 7. (2001).
35- Mc Loone NM, Tolland J, Walsh M, et al. Follow-up of basal cell carcinomas: an audit of current practice. J Eur Acad Dermatol Venereol. Jul 20(6):698- 701.(2006)
36- Grabski WJ, Salasche SJ. Positive surgical excision margins of a basal cell carcinoma. Dermatol Surg. Aug 24(8):921-4.(1998).
37- on April 13, (2011).
38- Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH. Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. Nov 13-19 364(9447):1766- 72. (2004)