From the Guidelines
Squamous cell carcinoma (SCC) excision margins from the face should be at least 4-6 mm.
Key Considerations
- For clinically well-defined, low-risk tumors less than 2 cm in diameter, a minimum 4-mm margin is appropriate 1.
- Larger tumors, high-risk tumors, or those in high-risk locations (such as the ear, lip, scalp, eyelids, or nose) should be removed with a wider margin (6 mm or more) 1.
- Mohs' micrographic surgery can be used to excise the tumor with minimal loss of normal tissue, especially in high-risk locations or when preserving tissue is crucial 1.
- The choice of margin width depends on the tumor's size, location, and risk factors, as well as the patient's overall health and preferences 1.
Rationale
The concept of a surgical margin is based on the assumption that the clinically visible margin of the tumor bears a predictable relationship to the true extent of the tumor 1. A wider surgical margin increases the likelihood of removing all tumor tissue. However, in some cases, such as in patients with epidermolysis bullosa, a more aggressive surgical approach may be necessary to reduce recurrence risk 1.
From the Research
Surgical Margins for Squamous Cell Carcinoma (SCC) on the Face
- The necessary margins for excising SCC from the face are not universally agreed upon, but several studies provide guidance on this issue 2, 3, 4.
- A study published in the Journal of cranio-maxillo-facial surgery found that a microscopic clear margin diameter (mCMD) of >4.1 mm was associated with no local recurrences (LR) in patients with facial cutaneous squamous cell carcinoma (cSCC) 2.
- Another study published in the Journal of plastic, reconstructive & aesthetic surgery found that national guidelines for operative radial margins predict 95% oncological clearance with a margin of 4 mm for low-risk and 6 mm for high-risk tumours 3.
- A retrospective study published in The New Zealand medical journal found that increased odds of positive margin on surgical excision were associated with increased tumour thickness, tumours from the head and neck, and those excised in primary care 4.
Factors Influencing Margin Status
- Tumour thickness, location, and excision in primary care are factors that can influence the likelihood of positive or close margins in SCC excisions 4.
- A study published in the Journal of clinical and aesthetic dermatology found that guideline recommendations for surgical excision margins vary among different types of nonmelanoma skin cancers, including basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma 5.
Recommendations for Surgical Margins
- The current evidence suggests that a surgical margin of at least 4-6 mm is recommended for excising SCC from the face, depending on the tumour's risk classification and location 2, 3.
- However, the optimal margin size may vary depending on the individual case, and further research is needed to determine the most effective and evidence-based approach to surgical excision for SCC 5.