The British Association of Dermatology-British Association of Plastic, Reconstructive and Aesthetic Surgery (BAD-BAPRAS) guidelines on excision of high-risk cutaneous squamous cell carcinomas (cSCCs) should be urgently updated, say the authors of a new study which showed that poorly differentiated cSCCs are frequently incompletely excised in both peripheral and deep planes, despite adherence to guidelines.
The findings come from a study by Cambridge University Hospitals NHS Trust which analysed demographics, surgical notes, and histological reports for all patients having a primary cSCC excised at Addenbrooke's Hospital in Cambridge between January 2017 and April 2018.
It found that close or involved peripheral margins were seen in 3% of well-differentiated lesions but in 13.2% of poorly differentiated lesions (odds ratio [OR] 45.02; P=0.003). Deep margins were close in 13.1% (none involved) of well-differentiated lesions but close or involved in 50% of poorly differentiated lesions (OR 11.94; P=0.001).
“We believe that UK guidelines for pre-determined margin surgical excision in high-risk cSCC should be increased in line with other national guidelines, and Mohs micrographic surgery (MMS) carefully considered on a case-by-case basis within an MDT setting,” the authors say.
Writing in the Journal of Plastic, Reconstructive & Aesthetic Surgery, they say: “Lesions should be assessed for expected histological grade pre-operatively using clinical appearance and dermatoscopy. Clinically high-risk cSCCs should be excised with a peripheral margin wider than 6 mm, and a deep margin extending to at least the next anatomical plane."
