Histopathological variation of incompletely excised basal cell carcinoma's and the variation with the grade of surgeon - implications for revalidation.

Background: Basal Cell Carcinomas are a condition commonly managed by Plastic Surgeons. National guidelines for their management where published in 2008. As part of revalidation, nine surgical subspecialities will publish individual surgeon outcome data for morbidity and mortality. Basal Cell Carcinoma incomplete excision rates have been postulated as an outcome measure for Plastic Surgeons.

Methods: We conducted a retrospective study of all Basal Cell Carcinomas within our unit from the 1st January to 31st December 2011. All patients were identified from the regional histopathology database and each histopathology report was analysed. Incomplete excisions were further analysed using a standard proforma.

Results: A total of 392 lesions were excised from 347 patients. In total there where 19 incompletely excised lesions with an overall incomplete excision rate of 4.8%. The temple area and inner canthus areas had the highest incidence of incomplete excision. Trainees encompassed 68% of all incompletely excised lesions. Histopathological analysis of the incompletely excised lesions showed that 60% of Consultant's incomplete excisions were morphoeic. Whereas for trainees, 54% were nodular, 30% infiltrative and the remainder morphoeic. Residual tumour was found in 36% of cases that were re-excised. No incompletely excised lesion that was followed up clinically, recurred after one year.

Conclusions: The incomplete excision rate was low and comparable with other published studies in the literature. Individual surgeon outcome data based on incomplete excision rates for Basal Cell Carcinoma is meaningless unless the location of the lesion and the histopathological subtype have been adjusted for.