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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40 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 r E v i E W defined as complex secondary to anatomic location, histologic sub- type, or ill-defined nature. The CCA/ACN advise use of 2 to 3mm peripheral margins for simple BCCs and 3 to 5mm for complex BCCs using SE. The deep margin is recommended to include subcutaneous fat. 12 Swedish guidelines. The Swedish guidelines, endorsed by the Section for Dermatologic Surgery and Oncology and the Swedish Society for Dermatology and Venereology, have also composed peripheral margin recommendations for the surgical excision of BCC. For small BCCs (not clearly defined), a minimum peripheral margin of 3 to 4mm via SE is advised. For highly aggressive BCCs, such as micronodular, metatypic, and recurrent types, a minimum peripheral margin of 5mm via SE is recommended (Table 2). 13 Cutaneous squamous cell carcinoma. cSCC is the second most common skin cancer worldwide, with incidence rates highest in the lower latitudes. A well-established relationship exists between cSCC and ultraviolet (UV) radiation, especially UVB. Other risk factors, such as arsenic exposure and the human papilloma virus (types 6, 11, and 16), have also been associated. 3 In comparison to BCC, cSCC has a greater propensity for invasive behavior and metastasis. Risk of metastasis is greater for lesions involving the scalp, forehead, ears, nose, and lips. Undifferentiated lesions greater than 6mm thick that have proceeded to invade deeper structures, including the musculature, perichondrium, or periosteum also have an increased risk of metastasis. cSCC types derived from transformed actinic keratoses tend to exhibit less Table 2. Basal cell carcinoma global guideline comparison of surgical margins 4,7,9,12,13 orGANizATioN PEriPHErAL MArGiNS DEEP MArGiNS Low-riSk LESioNS HiGH-riSk LESioNS Low- AND HiGH-riSk LESioNS NCCN Preferred: SE -4mm Preferred: MMS Alternative: SE -≥4mm Not specified EDF Preferred: SE -3–4mm Preferred: SE (or MMS) -5–10mm • Level of fascia, perichondrium, or periosteum where appropriate (especially for lesions of the head) • Less deep margins for superficial lesions or those in areas of thicker skin BAD Preferred: SE -4–5mm Preferred: SE (or MMS) ->5mm -≥13–15mm (primary morphoeic BCC) Through level of subcutaneous fat CCA/ACN Preferred: SE (or MMS) -2–3mm Preferred: SE (or MMS) -3–5mm To include level of subcutaneous fat Sweden Preferred: SE -≥3–4mm Preferred: SE -≥5mm Not specified British Association of Dermatology (BAD), Cancer Council Australia and Australian Cancer Network (CCA/ACN), European Dermatology Forum (EDF), National Cancer Care Network (NCCN), Mohs micrographic surgery (MMS), standard excision (SE)

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