Incidence of incomplete excision in surgically treated basal cell carcinoma: a retrospective clinical audit

All the patients who had excision of basal cell carcinoma at the regional p lastic surgery unit at Manchester over a period of 2 years from January 199 5 to December 1996 were included in a retrospective audit. A total of 879 l esions were excised in 754 patients. In 41 lesions (4.7%) the tumour was in completely excised, 16 of these lesions were further excised; the rest were managed by regular follow-up. The mean age of the incomplete excision grou p was slightly higher. The site where the incomplete excision rate was high est was the scalps followed by the ear, canthi, eyebrows and nose. There wa s a higher incidence of squamous differentiation and presence of foci of sq uamous cell carcinoma in the lesions excised incompletely. There was no statistically significant difference among the different group s of surgeons but in individual grades the rate was lower where more wounds were repaired by direct closure. The concept of a complexity ratio (number of wounds repaired by other methods/number of wounds repaired by direct cl osure) can be helpful in comparing the incomplete excision rates of differe nt grades of surgeons or departments. The excision of basal cell carcinoma is one of the commonest procedures per formed by all grades of surgeons in a plastic surgery department. Incomplet e excision leads to further surgery or prolonged follow-up, thus significan tly affecting the outcome. As the incidence of incomplete excision can be p recisely monitored, it may be a useful tool for clinical governance. (C) 20 00 The British Association of Plastic Surgeons.