This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (24)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

R. Sonia Batra, MD, MSc, MPH; Larisa C. Kelley, MD

Arch Dermatol. 2002;138:1043-1051.

Background  In nonmelanoma skin cancer, the clinically visible portion may represent a small fraction of microscopic tumor spread. Previous studies have examined individual risk factors for subclinical spread based on patient and tumor characteristics. However, these risk factors have not been prioritized or studied in combination.

Objective  To identify the most predictive risk factors for extensive subclinical tumor spread.

Design  Retrospective analysis of 1131 Mohs micrographic surgical cases. Variables analyzed included patient age, sex, and immune status and lesion size, location, histologic subtype, and recurrence. Logistic regression was applied to identify important combinations of tumor characteristics and to quantify relative odds of spread.

Setting  Academic referral center.

Patients  Consecutive sample of all referred patients treated by a single Mohs micrographic surgeon in a 3-year period.

Main Outcome Measure  Number of Mohs micrographic surgical layers required to clear a tumor, with 3 or more layers defined as extensive subclinical spread.

Results  The highest-risk tumors, with odds ratios greater than 6.0, were basosquamous and morpheaform basal cell carcinoma (BCC) on the nose, morpheaform BCC on the cheek, and those with a preoperative size greater than 25 mm. Other important risk factors were recurrent and nodular BCC on the nose; location on the eyelid, temple, or ear helix; neck tumors and recurrent BCC in men; and tumor size greater than 10 mm. Patients younger than 35 years were at lower risk. Increasing age and immunocompromise were not significant predictors.

Conclusion  Identification of lesions likely to exhibit extensive subclinical spread can help guide management to ensure complete tumor eradication and thereby reduce the risk of recurrence and its associated morbidity and cost.

From the Departments of Dermatology, Stanford University School of Medicine, Stanford, Calif (Dr Batra), and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (Dr Kelley).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Basal-Cell Carcinoma.
Rubin et al.
NEJM 2005;353:2262-2269.
FULL TEXT  

Surgery for primary basal cell carcinoma including the eyelid margins with intraoperative frozen section control: comparative interventional study with a minimum clinical follow up of 5 years
Conway et al.
Br J Ophthalmol 2004;88:236-238.
ABSTRACT | FULL TEXT  

Predicting Subclinical Spread in Nonmelanoma Skin Cancer
Journal Watch Dermatology 2002;2002:1-1.
FULL TEXT