Open Access

Deborah Lina Salewski

• Ziel der Arbeit ist es die Eigenschaften und die Häufigkeit von Rezidiven der primär und sekundär therapierten Basalzellkarzinome der MKPG, insbesondere in Abhängigkeit der Lokalisation und des Resektionsstatus zu evaluieren und mit den Ergebnissen der Literatur zu vergleichen, um ein optimiertes chirurgisches Vorgehen zu sichern.
• From 2011 to 2020, 80 patients underwent basal cell carcinoma surgery in the Department of Oral and Maxillofacial Plastic Surgery. The patient population was recruited using DRG codes via the search function in Orbis. Subsequently, patient-specific and demographic data were analyzed. As a maximum care hospital with more than 25 different internal specialist departments, the University Hospital Frankfurt am Main has a wide range of treatment options. The low number of 85 patients in our study can be explained on the one hand by the versatile disciplines and on the other hand by the large dermatosurgery department of our hospital, which operates about 300 basal cell carcinomas per year. The evaluation of our data has shown that the treatment of basal cell carcinoma in our clinic for oral and maxillofacial plastic surgery is limited to highly complex cases. The majority of patients are due to referrals from the local dermatology or ophthalmology department. The most common reason for referral was incomplete resection or recurrence on sensitive cosmetic sites, where complex defect coverage is often required to maintain aesthetics. From the low number of corrective procedures in our study, we can infer a high aesthetic standard and patient satisfaction with our surgical approach. Although the majority of basal cell carcinomas are located in the H zone, our clinic achieves R1 resection rates that are comparable to those reported in the literature. Analysis of patient data from our clinic has shown that differentiation into primary and secondary carcinomas is essential for surgical treatment planning. Thus, the hypothesis that R1-resected basal cell carcinomas recur more frequently than R0-resected basal cell carcinomas could be confirmed both in the group of primary and secondary basal cell carcinomas. However, the recurrence of secondary basal cell carcinomas is twice as high as that of primary carcinomas. Thus, despite R1 resection, the group of primary basal cell carcinomas showed a low number of recurrences. Therefore, we are of the opinion that primary basal cell carcinomas should also be treated with the therapy alternative "watch and wait" in case of incomplete resection in order to preserve esthetics. However, this requires a good patient compliance as well as an adequate follow-up. R1-resected secondary cases developed recurrence with almost equal frequency in R1 and R0 resection. Therefore, in our view, these patients should undergo mandatory resection or require adjuvant therapy. The reason for this recommendation is the proven high incidence of tumor extensions in R1-resected tumors, the detection of more aggressive subtypes, and the frequent occurrence of recurrences despite R0 resection. Similar to other studies, a positive deep incision margin and an aggressive histologic subtype were identified as risk factors for the development of recurrence in our study.With regard to anatomic location, the periorbital area stood out as a location with increased risk of recurrence in our patients. An evenly distributed risk of recurrence in the H zone area was not demonstrated in our data. Rather, our results showed that risk stratification cannot be accurately applied in the case of secondary carcinomas, as the group carries an equal risk of recurrence in the H- and M-zone. The type of defect coverage and evidence of ulceration and perineural sheath invasion in the histologic specimen do not influence the recurrence rate. With a recurrence rate of 12%, our Department of Oral and Maxillofacial Plastic Surgery achieves a recurrence rate similar to that reported in the literature with a conventional surgical approach for complex craniofascial basal cell carcinoma.