Nonpersistence of basal cell carcinoma after diagnostic shave biopsy: reconstruction when specimen is negative during surgery.

Background: Initial tissue sampling for diagnosis of suspected basal cell carcinoma (BCC) is typically performed using a shave biopsy technique or punch biopsy.

Methods: Our realization of no residual BCC findings after excision in some patients with biopsy-proven BCC diagnosed through a shave biopsy prompted us to conduct a retrospective study of all consecutive patients with 127 BCCs who were treated in our department between 2006 and 2012. All patients with incompletely excised BCCs after shave biopsy diagnosis were operated on by a single surgeon (R.G.), eliminating variables in preoperative evaluation and surgical technique including margin control and reconstructive approach. Patient demographics, initial BCC site, size, subtype, duration between shave biopsy and surgery, size of excision, findings of intraoperative frozen section analysis, type of closure technique, and final pathology reports were analyzed.

Results: There were 108 residual BCCs diagnosed after surgical excision. Most of the108 BCCs were nodular (52) or micronodular (21) subtype. Eighteen BCCs were treated with excision and primary closure. Flap procedure was performed in 64 BCCs after excision. Twenty-six defects after excision were reconstructed using skin grafts. There was no evidence of residual BCC in 15% of BCCs (19 patients) after surgical treatment. In other words, shave biopsy was found to be curative in 15% of BCCs. Seven patients in no residual BCC group received excision and primary closure. Eleven patients underwent flap reconstruction, whereas only 1 patient required skin grafting. Most of the patients in this group had nodular or micronodular type BCC (14/19).

Conclusions: We were not able to identify any clinically significant predictors of residual versus no residual BCC, at least within the context of the current study. Although most patients diagnosed with BCC had residual tumors for which they received surgical treatment, 15% of patients had to undergo primary closure, skin graft, or flap procedure for negative residual BCC. We would like to promote greater awareness on the subject among plastic surgeons treating BCCs. And, it is extremely important that the informed consent should include statements regarding possible reconstructive procedures even in the case of nonpersistent tumor from medicolegal standpoint.