Basal Cell Treatment Standard Surgical Excision

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Standard surgical excision usually uses either:

• Frozen section histology, or
• Parafin embedded fixed tissue pathology

Standard Surgical Excision is a preferred removal method of basal cell carcinoma (BCC) and/or for this skin cancer treatment. The cure rate for this method, whether done by a plastic surgeon, family doctor, or dermatologist is totally dependent on the surgical margin. When standard surgical margin is applied (usually 4 mm or more) a high cure rate can be achieved with standard excision. The narrower the free surgical margin (skin removed that is free of visible tumor) the higher the recurrence rate.



This skin cancer treatment has a weakness that is a high recurrence rate of basal cell cancers of the face, especially around eyelids, nose, and facial structures. On the face, or on recurrent basal cell cancer after previous surgery, special surgical margin controlled processing (Mohs surgery is one of the methods) is required. With surgical margin controlled frozen section histology, a surgeon can achieve a high cure rate and low recurrence rate on the same day of the excision.

However, most standard surgical excisions done in a plastic surgeon or dermatologist's office are sent to an outside laboratory for standard bread loafing method of processing. This method has a high "false negative" rate due to the random sampling of the tumour. For cosmetic reasons, many doctors take only very small surgical margins 1-2 mm, especially when facial tumour is being removed. A pathology report from such a case indicating "margins free of residual tumour", often is inaccurate, and a high recurrence rate of up to 38% might occur.


When in doubt, a patient should demand that either Mohs surgery or frozen section histology with either margin control or thin serial bread-loafing is utilized when dealing with a tumour on the face. The pathologist processing the frozen section specimen should cut multiple sections through the block to minimize the false negative error rate. Or one should simply process the tissue utilizing a method approximating the Mohs method during frozen section processing.


However, this method is difficult when applied to frozen sections; and is very tedious to process. When not utilizing frozen section, the patient might have to wait a week or more, before informing the patient if more tumors are left, or if the surgical margin is too narrow. And a second surgery must be performed to remove the residual or potential residual tumour once the surgeon inform the patient of the positive or narrow surgical margin on the surgical pathology report.

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