Basal cell carcinomas may carry high likelihood of recurrence

Recurrent basal cell carcinomas and primary basal cell carcinomas have a high likelihood of recurrence, according to a presentation at the European Academy of Dermatology and Venereology virtual congress.

“Basal cell carcinomas are exceedingly common cutaneous malignancies and major causes of functional and cosmetic impairment,” Bruno Duarte, MD, of the dermatology and venereology department at Centro Hospitalar Universitario de Lisboa Central, Portugal, and colleagues wrote. “Mohs surgery offers higher rates of cure, but its high cost and limited availability in Portugal requires that most tumors are treated with conventional surgery. There is also controversy whether follow-up or immediate re-intervention is the optimal treatment for incompletely excised basal cell carcinomas.”

In a single-center retrospective cohort study, researchers analyzed 2,306 basal cell carcinomas (2,100 primary basal cell carcinomas and 206 recurrent basal cell carcinomas) for risk factors and to acquire long-term follow-up data regarding treatment with conventional surgery. Researchers performed further survival analysis with Cox proportional hazards models stratified by completeness of excision.

During a 5-year follow-up period, researchers observed a 4% recurrence among complete excisions and a 23.9% recurrence among incomplete excisions. Final adjusted models identified associations between relapse and re-intervention on recurrent tumors (adjusted HR 2.20; 95% CI, 1.26-3.84; P = .006), wrong clinical diagnosis or surgery devoid of preoperative biopsy (adjusted HR 2.75; 95% CI, 1.68-4.5; P < .001), prior treatment earlier than 2012 (adjusted HR 1.47; 95% CI, 1.06-2.05; P < .021) and surgery on high-risk locations (adjusted HR 2.18; 95% CI, 1.08-4.40; P < .030). Further analysis showed a higher likelihood of recurrence on the nose and eyelids with a trend toward higher recurrence in aggressive histological subtypes.

“Recurrent tumors and primary lesions on eyelids, preauricular area and nose are highly prone to recurrence and may be prioritized for Mohs referrals,” Duarte and colleagues wrote. “At 5-years, one in 10 incompletely excised tumors will recur. Careful long-term follow-up is needed if immediate re-excision is not performed.”