The specialty of the treating physician affects the likelihood of tumor-free resection margins for basal cell carcinoma: Results from a multi-institutional retrospective study

Background: Basal cell carcinoma (BCC) is the most common cutaneous maligna ncy. Surgical experience and physician specialty may affect the outcome qua lity of surgical excision of BCC. Methods: We performed a multicenter retrospective study of BCC excisions su bmitted to the respective Departments of Pathology at 4 major university me dical centers. Our outcome measure was presence of histologic evidence of t umor present in surgical margins of excision specimens (incomplete excision ). Clinician experience was defined as the number of excisions that a clini cian performed during the study interval. The analytic sample pool included 1459 tumors that met all inclusion and exclusion criteria. Analyses includ ed univariate and multivariate techniques involving the entire sample and s eparate subsample analyses that excluded 2 outlying dermatologists. Results: Tumor was present at the surgical margins in 243 (16.6%) of 1459 s pecimens. A patient's sex, age, and tumor size were not significantly relat ed to the presence of tumor in the surgical margin. Physician experience di d not demonstrate a significant difference either in the entire sample (P < .09) or in the subsample analysis (P >.30). Tumors of the head and neck wer e more likely to be incompletely excised than truncal tumors in all the ana lyses (P <.03). Compared with dermatologists, otolaryngologists (P <.02) an d plastic surgeons (P <.008) were more likely to incompletely excise tumors ; however, subsample analysis for plastic surgeons found only a trend towar d significance (P <.10). Dermatologists and general surgeons did not differ in the likelihood of performing an incomplete excision (P >.4). Conclusion: The physician specialty may affect the quality of care in the s urgical management of BCC.