From the Research
The recommended excision margins for a basal cell carcinoma (BCC) on the nose are 6 mm for high-risk BCCs, as this margin is associated with 86.46% of complete excision, according to the most recent and highest quality study 1.
Key Considerations
- The nose is considered a high-risk anatomical site due to its cosmetic importance and the higher risk of recurrence in this area.
- Risk stratification is important when determining the appropriate margin - factors such as tumor size, histological subtype (with morphoeic, infiltrative, and micronodular subtypes requiring wider margins), previous recurrence, and immunosuppression status all influence the decision.
- For very large, aggressive, or recurrent BCCs on the nose, Mohs micrographic surgery might be preferred to maximize tissue preservation while ensuring complete tumor removal.
Evidence Summary
- A study published in 2024 found that a 6mm safety margin was associated with 86.46% of complete excision in high-risk BCCs 1.
- Another study published in 2020 found that BCCs less than 6 mm had a clearance rate of 96% with 3-mm margins, but this study did not specifically address high-risk BCCs on the nose 2.
- A review of 15 studies 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, but this review did not specifically address high-risk BCCs on the nose 3.
Clinical Implications
- The choice of excision margin should be individualized based on the specific characteristics of the tumor and the patient.
- Careful histological assessment is essential to confirm clear margins after excision.
- Mohs micrographic surgery may be considered for high-risk BCCs on the nose to maximize tissue preservation while ensuring complete tumor removal.