Evaluation of The Best Surgical Margin for Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) is one of the non-melanocytic malignancies of the skin, originating from the epidermal basal cells. It is considered the most common skin malignancy in humans. The treatment should remove the lesion with preserving the maximum level of healthy surrounding tissues. So, treatment is controversial between adequate safety margin and leaving satisfactory cosmetic results. Objective: In this study, we aim to evaluate the intact safety margin for BCC post-operative, being regarded as 3 mm or more before surgery (pathologically by routine and immunohistochemical staining using BerEP4).  Patients and Methods: The study included 40 patients presented with basal cell carcinoma (BCC). All were assessed for the duration, size, type, and site of the lesion. The treatment of the primary lesion and recurrence time was reported for all cases. Different reconstructive types of local fascio-cutaneous flaps were performed. The excised specimens were referred to pathological verification of the diagnosis and evaluation of the boundaries, either free or infiltrated. Results: There was a statistically significant association between recurrence and tumor size (p=0.001), deep facial invasion (p < 0.001), muscle invasion (p=0.001), ill-defined tumor borders (p < 0.001), positive surgical margins, and safety margins size (p < 0.001). Conclusion: Excision of BCC with 3 mm or more as a safety margin is enough to preserve healthy tissues and avoid the requirement for difficult procedures of reconstruction. The use of BerEP4 is a highly specific marker for detecting BCC cells that, can be missed by routine H&E staining.