Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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39 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 r E v i E W European Dermatology Forum. The European Dermatology Forum (EDF) guidelines on surgical excision margins of BCC represent a compilation of recommendations based on the British Association of Dermatology guidelines (BAD), French guidelines, and previous EDF guidelines. 6–8 Low-risk BCC, defined as less than 2cm in diameter, should undergo SE using 3 to 4mm peripheral margins. 9,10 For high-risk BCC, defined mainly by larger size, it is appropriate to perform SE using 5 to 10mm peripheral margins. The EDF cites that previous studies showed complete clearance in 95 percent of cases when such margins were used. MMS is an alternative surgical therapy in appropriate candidates. 9,10 Where appropriate, deep margins should extend to the level of the fascia, perichondrium, or periosteum, especially when involving the head. For superficial BCCs or those located in areas where there is thicker skin, the deep margin need not be as deep. 9 The overall approach should be tailored to the type of BCC. 9,11 British Association of Dermatology. According to the British Association of Dermatology (BAD) guidelines, 4 to 5mm peripheral margins are recommended using SE for low- risk BCC. The BAD guidelines reference a study by Wolf and Vitelli, which showed a complete excision rate of 95 percent using a 3.79mm surgical excision margin. 5,7 For high-risk BCC, BAD guidelines suggest greater than 5mm peripheral margins for high-risk BCCs using SE. For primary morphoeic BCC, an extended margin greater than or equal to 13 to 15mm is recommended. MMS is an alternative surgical therapy for high-risk BCC in appropriate candidates. 7 Deep margins are recommended to extend to the level of subcutaneous fat. 7 Cancer Council Australia and Australian Cancer Network. The Cancer Council Australia and Australian Cancer Network (CCA/ACN) guidelines categorize BCC lesions as simple and complex when determining appropriate surgical excision margins. Simple BCCs are defined as small, nodular, or superficial, and not located on the central face. Complex BCCs are Table 1. Body areas 2 ArEA H ArEA M ArEA L "Mask areas" of the face Central face Eyelids, including inner/outer canthi Nose, chin, temple Lips, including cutaneous, mucosal, and vermillion surfaces Ears, including periauricular skin/sulci Cheeks Trunk Hands, ankles, feet Forehead Extremities Excluding pretibial area, hands, feet, ankles, and nail units Nail units Jawline Nipples, areola Neck Genitalia, including perineal and perianal areas Scalp Pretibial area

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