From the Guidelines
4-mm clinical margins are necessary for excising nodular basal cell carcinoma (BCC) from the nose.
Excision Margins for BCC
- The National Comprehensive Cancer Network (NCCN) guidelines recommend standard excision with 4-mm clinical margins for low-risk basal cell skin cancer, including nodular BCC, if the lesion can be excised with these margins and second intention healing, linear repair, or skin graft is possible 1.
- A study published in the Journal of the National Comprehensive Cancer Network supports the use of 4-mm clinical margins for excising basal cell tumors smaller than 2 cm in diameter and clinically well circumscribed, with a 95% confidence interval for complete removal 2.
- It is essential to note that these margins are recommended for low-risk tumors, and the specific location of the tumor, such as the nose, does not alter the recommended margin size in the provided evidence.
- The choice of reconstruction approach, such as side-to-side closure, skin grafting, or secondary intention healing, depends on the ability to excise the lesion with the recommended margins and the resulting defect 2.
From the Research
Margins for Excising Nodular Basal Cell Carcinoma (BCC) from the Nose
- The necessary margins for excising nodular basal cell carcinoma (BCC) from the nose have been studied in several research papers 3, 4, 5, 6, 7.
- A study published in the Journal of the American Academy of Dermatology found that nodular BCCs less than 6 mm may be cleared with 3-mm margins instead of the current 4-mm margin recommendation 3.
- Another study published in Cureus found that for primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm gives satisfactory results 4.
- A study published in the Archives of craniofacial surgery found that 2-3 mm excision margins can yield enough safety in facial BCCs, with recurrence rates comparable to those reported after wider margins 5.
- A retrospective study published in the Journal of plastic, reconstructive & aesthetic surgery found that nodular, superficial and mixed non-infiltrative BCC can usually be safely excised with a cuff of fat alone, which corresponds to a deep margin of subcutaneous fat 6.
- A clinicopathological study published in Annals of medicine and surgery found that primary tumors of all studied recurrent BCCs were excised with surgical margins less than 4 mm, highlighting the importance of follow-up for all excised BCCs 7.
Specific Margin Recommendations
- For nodular BCCs less than 6 mm, a 3-mm margin may be sufficient 3.
- For primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm is recommended 4.
- For facial BCCs, 2-3 mm excision margins may be sufficient 5.
- For nodular, superficial and mixed non-infiltrative BCC, a deep margin of subcutaneous fat may be sufficient 6.