BASAL CELL CARCINOMA

VARIOUS SURGICAL OPTIONS IN THE MANAGEMENT

Abstract

Introduction:- Basal cell carcinoma is the most common skin
malignancy, accounting for about 80% of all skin cancers and may be lethal. Its recognition and management should
be familiar to all the general surgeons. Objective:- To describe the prevalence, mode of presentation and various
surgical options of reconstruction in the management of basal cell carcinoma (BCC) with a local perspective. Setting:-
Nishtar Hospital, Multan. Duration:- One year (October 2002 to September 2003). Sample size:- 60 patients. Study
design:- Descriptive study. Results:- Out of sixty cases, 50 (83%) were male and 10 (17%) were female. Majority of
the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to
female ratio was 5:1. Out of 60 cases 26 (20 male, 6 female) 43.3% were farmer, 16 (all male) 26.6% was construction
workers, 10 (8 male, 2 female) 16.6% were unemployed and 8 (all female) 13.3% were household. No patient presented
before 5 years after the development of the lesion. 34 (30 male, 4 female) 56.6% for the last 6-10 years, 20 (16 male,
4 female) 33.3% for the last 11-15 years, 2 (all male) 3.3% for 16-20 years and 4 (2 male, 2 female) 6.6% had lesions
for > 20 years. All the lesions encountered in present study occurred on exposed head and neck region as is evident
from the table-III. Most of the patients had the nodular pigmented type of BCC and majority of them were male. None
of them have Gorlin’s syndrome (Table-IV). Common variant on histopathology was found to be solid type with
adenocystic type being the commonest lesion. After the excision of the lesion the skin defect most of the time was
closed by the mean of split skin graft. Direct closure was done in quarter of the patients. A number of postoperative
complications were observed after various reconstructive procedures. Wound was found to be commonest complication;
with majority of cases getting only minor wound infection. Conclusion:- Delay in presentation has an overall negative
effect on the outcome. A simple excision, excision biopsy with adequate margin clearance gives surgeon more freedom
for reconstruction.