Facial cutaneous squamous cell carcinoma - microscopic safety margins and their impact on developing local recurrences

D G E Thiem; K Scharr; A M Pabst; B Saka; P W Kämmerer

doi:10.1016/j.jcms.2019.11.022

Facial cutaneous squamous cell carcinoma - microscopic safety margins and their impact on developing local recurrences

J Craniomaxillofac Surg. 2020 Jan;48(1):49-55. doi: 10.1016/j.jcms.2019.11.022. Epub 2019 Nov 29.

Authors

D G E Thiem¹, K Scharr², A M Pabst³, B Saka², P W Kämmerer⁴

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany. Electronic address: daniel.thiem@unimedizin-mainz.de.
² Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany.
³ Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany.
⁴ Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany.

PMID: 31810842
DOI: 10.1016/j.jcms.2019.11.022

Abstract

Objectives: Surgical excision remains the treatment of choice for facial cutaneous squamous cell carcinoma (cSCC) despite there being no generally accepted diameter of clear margins. Therefore, the aim of this study was to evaluate the impact of microscopic clear margins diameter (mCMD) with respect to the development of local recurrences (LR).

Materials and methods: The medical records of 99 patients with a total of 142 cases of facial cSCC, who underwent surgical treatment between January 2010 and December 2015, were reviewed for demographic data and clinicopathological features.

Results: 100 cases were diagnosed as primary cSCC and 42 cases as secondary cSCC. Of these, nine (6.3%) developed LR. Mean time to LR was 20 months, with the cheek as the predominant site 55.5% (n = 5). Wound closure was either primary (56%) or secondary (44%), depending on the site. Although no significant correlation between mCMD and LR was found (r_Pearson = 0.029; r_Pearson = 0.015), >4.1 mm was shown to be a negative cut-off-value (horizontally and vertically) without LR (100% vs 0%).

Conclusions: Based on these results, however descriptive they are, the authors consider histological confirmation of clear margins to be necessary for reducing the formation of LR. Thus, consistent testing and histopathological reporting, in a multicentered effort, are needed to further clarify the role of mCMD in the development of cSCC-LR.

Keywords: Cutaneous squamous cell carcinoma; Local recurrence; Microscopic clear margin diameter; Risk factor; cSCC.

MeSH terms

Carcinoma, Squamous Cell*
Face
Humans
Margins of Excision
Neoplasm Recurrence, Local
Skin Neoplasms*