Surgical Plan Of Facial Basal Cell Carcinoma Of Lower Recurrence And Clinical Pathologic Analysis

Objective: To discuss pathogenesis and clinicopathological parameters of facial basal cell carcinomas(BCC)and the relationships between study variables and margin status,prognosis and the aesthetic effect with different methods of wound repair.Methods: Retrospectively analyzed 310 cases of BCC since January 1st 2009 to January1 st 2012 diagnosed by department of plastic surgery and department of pathology in Anhui Provincial Hospital.According to margin status and prognosis,all patients were invided to groups including positive margin and negative margin,relapse and relapse free.Histology characteristics were analyzed through HE staining and En Vision method.Study variables were the sex,age,months awaited before treatment,tumor diameter,location,histologic subtype.Results: The primary outcome variables were the rate of initially positive frozen section margins and recurrence rate followed up five years.The primary outcome variable were the rate of initially positive frozen section margin and recurrence rate followed up five years.The relationship between study variables and margin status were studied by using Chi-square test and Logistic multi-factor regression analysis.Using Kaplan-Meier depicting suvival curve of BCC.Creating Cox's proportional hazards regression model to explain the relationship between study variables and recurrence.Of the 310 cases,margin of 47 cseses were positive.Tumors were treated with different surgical margins of excision: 3 mm,110cases;4 mm,100cases;and 5 mm,100 cases.Four major histologic patterns were identified: nodular,138 cases;superficial,67cases;infiltrative,77cases and morpheaform,28 cases.70 cases in temporal;50cases in orbital;100cases in nasal;56 cases in cheek;34 cases in jaw.The diameter was 2.0-27.0mm.The duration was 4-48 m.There were 22 cases were recurrent.Methods of repair were direct suture,112cases;making flap,168 cases;skin graft,30 cases.Logistic analysis indicated pathological subtype and tumor diameter were the major risk factor.The infiltrative(OR=4.488,95%CI=1.975 ~ 10.355,P<0.05),morpheaform(OR=5.019,95%CI=2.025 ~ 16.629,P<0.05)and diameter over 15mm(OR=2.013,95%CI=1.196 ~ 8.475,P<0.05)had higher risk on positive surgical margin.Cox's proportional hazards regression indicated pathological subtype and tumor diameter were the major risk factor.The infiltrative(HR=3.437,95%CI=1.018~11.605,P<0.05),morpheaform(HR=5.912,95%CI=1.548~22.579,P<0.05)and diameter over 15mm(HR=3.142,95%CI=1.221~12.330,P<0.05)had a greater risk of recurrent.However,the rate of initially positive margins and recurrence of nodular basal cell carcinoma at different margins were observed but the difference were not significant(P>0.05).Conclusion: The pathological subtype and tumor diameter are the major risk factors.Surgical excision with a 3 mm margin can achieve ideal results for nodular basal cell carcinoma in facial area.