Basal Cell Carcinoma: Surgical Therapy

Therapy goals

  • Histologically (fine tissue) complete excision (surgical removal).
  • Functional and aesthetically adequate reconstruction.
  • Avoidance of recurrence (recurrence of the disease).

Surgical therapy

Surgical therapy of basal cell carcinoma (BCC).

Superficial BCC Solid BZK BCC with high risk of recurrence (sclerodermiform, micronodular, metatypical, infiltrative; recurrent tumor, tumor > 1 (-15 mm) cm)BCC with problem localization (eyelids, nose, lip, ears)
Conventional excision (or shallow horizontal excision/shave excision).
  • Tumors <2 cm in diameter → excision with 3-4 mm safety margin.
  • Tumors ≥ 2 cm in diameter → excision with 5 mm safety margin, histological incision margin control.
  • Tumors
  • Tumors ≥ 1 cm in diameter → excision with 5 mm safety margin: micrographic controlled surgery.

1st order (first choice therapy)

  • Excision (surgical removal of the skin lesion), with histologic control of complete resection in healthy tissue, is performed with:
    • Mohs histographic/micrographic surgery (MKC, “Mohs” surgery) – smallest possible excision of the tumor (with a size <1 cm) in healthy tissue, as performed at sites such as the hand, foot, ankle, tibia, nipple, or genital (where the risk of recurrence is particularly high); however, not for tumors on the trunk and extremities, where the clinical benefits of Mohs micrographic surgery do not outweigh the potential risks of this method
    • Conventional surgery (safety margin: 0.3-0.5 (-1) cm).

Further notes

  • Note: One in four patients with BCC biopsy in healthy subjects still had BCC remnants detected at subsequent excision, i.e., a negative margin finding in the BCC biopsy appears to be of little informative value. The negative predictive value of a tumor-free margin in the biopsy was only 76%.
  • Regarding their recurrence behavior (recurrence of the tumor).
    • Low-risk classified tumors <2 cm in diameter: safety margin of 3-4 mm.
    • Larger low-risk or small high-risk basal cell carcinomas: safety margin of 5 mm.
  • If incomplete resection – then all surgical options for post-excision or resection must be perceived, as far as this allows the tumor extent and the general condition of the patient. This applies in particular to all basal cell carcinomas of the infiltrative and sclerodermiform type. Furthermore, this applies to infiltrations of deeper structures that are not limited to the skin alone.
  • In locally advanced (lfBZK) or metastatic BZK, the treatment concept should be determined by an interdisciplinary tumor board.