Head and neck cutaneous basal cell carcinoma: a retrospective analysis of tumour features, surgical margins and recurrences

Purpose The aim of this study was to analyse the factors affecting the status of surgical margins and recurrence of basal cell carcinoma (BCC) of the head and neck. A secondary aim was to provide detailed demographic, clinical and topographic data to understand the biological behaviour of this skin cancer in head and neck area. Methods A retrospective analysis was conducted analysing all primary head and neck BCCs treated from July 2014 to October 2021. Chi-square and logistic regression were used to assess the presence of statistically significant associations. Results The study cohort included 307 patients who underwent resection of 377 BCCs. The mean age of the patients was 76.86 years. There were 251 (67%) clean surgical margins, 80 (21%) positive and 46 (12%) closed. Recurrences were observed in 11 (5%) out of 218 BCCs of patients with a minimum follow-up of 24 months. The median follow-up time was 35 months. Positive margin status was significantly associated with BCC of the nose, while clean margin was correlated with neck localization (p<0.05). Clean margin status was linked with direct closure (p<0.05), while positive and closed margins were significantly associated to local flaps (p<0.05). Positive margin status was significantly related to depth of invasion below the dermis (p<0.05). Conclusion The location, depth of invasion and method of reconstruction of head and neck BCC influence the completeness of surgical resection. Considering the low recurrence rate, clinical observation is an acceptable management option in patients with compromised margins, especially in elderly and frail patient populations.