A quality audit of outcomes in wide local excision of non-melanoma skin cancers at Chris Hani Baragwanath Academic Hospital

Abstract

Background: Non-melanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common malignancies and account for one-third of cancer diagnoses. This places a significant burden on the healthcare system, particularly when inadequately treated. The gold standard of care for NMSC is Mohs Micrographic Surgery (MMS). When MMS is unavailable, a macroscopic marginal margin is recommended by the National Cancer Care Network (NCCN) guidelines. The primary objective of this study was to determine the cancer clearance rate of wide local excision in NMSC treatment. Methods: This study was a single centre retrospective file review of patients who had undergone wide local excision of NMSC at Department of Plastic and Reconstructive Surgery, Chris Hani Baragwanath Academic Hospital (CHBAH) between 1st September 2021 and 31st August 2024. Results: In all, 158 cases were reviewed ( BCC=116, SCC=42). Cancer clearance was achieved in 134 patients (84.8%). Most NMSCs involve the head and neck, which also had the most incomplete excisions. Cancers with involved margins were generally smaller. In BCC and SCC, nodular subtype and moderately differentiated keratinizing were the most common respectively. SCCs had a proportionally higher margin involvement, particularly deep margins. Thicker tumours (>2mm) had a higher risk for margin involvement. Conclusions: Most patients achieved a disease-free status. However, some may be at risk for incomplete excision. These include NMSCs involving the head and neck ix region, aggressive subtypes of BCC and SCC, and tumour thickness over 2mm. MMS may be considered for improved quality of care.