Incomplete excision of basal cell carcinoma (BCC) in the head and neck region: to wait, or not to wait?

Introduction Recurrence rates for incompletely excised basal cell carcinoma (BCC) vary widely in the literature. Clinical observation is a commonly accepted method of follow up, however such management of these lesions still remains controversial. Aim To evaluate the rate and factors associated with the recurrence of BCC of the head and neck region after incomplete excision. Material and methods Medical records of 135 patients with 156 incompletely excised BCCs of the head and neck region were analyzed retrospectively. The primary outcome was the rate of recurrence. Additionally, a correlation of recurrence to clinical and morphological factors was analyzed. Results Recurrence occurred in 72 (46%) lesions. The mean interval to recurrence was 20 months. In each category of factors, the highest relative risk of recurrence was correlated to: location on the scalp - 2.27, diameter over 2 cm - 1.21, nodular clinical form - 1.29, morpheaform histopathological type - 1.67, recurrent lesion - 1.88, irradicality of excision in the lateral margin - 1.24 and closure of the skin defect with the split-thickness skin graft - 1.42 relative risk. Conclusions Observation is an acceptable management option as less than a half of incompletely excised BCCs recurred and needed further treatment. As 85% of recurrences occur within 3 years after operation, clinical observation should be particularly careful during this period, however long-term recurrence should not be underestimated.