ASSESSMENT OF PROGNOSTIC FACTORS FOR THE RECURRENCE OF SKIN BASAL CELL CARCINOMA

Farah Adib Maarouf* and Firas Moulhem

ABSTRACT

Study Aim: to determine the prognostic factors for recurrence of basal cell carcinoma, which enables determining the optimal surgical procedure to reduce the rate of recurrence, achieve recovery in a short period of time, allow the patient to return to work, and reduce the medical costs incurred due to repeated surgical procedures. Material and Methods: The study was conducted in the Reconstructive Surgery Division at Tishreen University Hospital, from June 2023 to June 2024. The study was designed prospectively, and at the end of the study, 32 patients were included. After taking the patient's consent, his clinical history, and filling out his form, preparations were made for the surgery, the necessary consultations and tests were performed, then a complete excision of the lesion was performed with an appropriate safety margin, and the samples were sent for histological analysis. The appropriate reconstructive method was chosen after the histopathology result was issued. Results: The number of patients in our study was 46 patients, where the number of male patients was 64, representing 56.63%, and the number of female patients was 44, representing 34.37% of the patients visiting the Department of Reconstructive Surgery at Tishreen University Hospital. The average age of patients in our research was 68.14 years with a standard deviation of 12.34. The youngest age treated in our research was 11 years and the oldest was 87 years. Most of the lesions were located in the head and neck regions at a rate of 62.50%, followed by the trunk and lower extremities at a rate of 25.00% and 12.5%, respectively. The vast majority of the study patients reported a history of previous sunburn, whether once or several times, as their number reached 29 patients out of 32. Sick, with a rate of 90.63%. The largest percentage of lesions were of the superficial and nodular types, at 27.83% and 41.43%, respectively, while the least common type was the infiltrative type, which was present in 7.14% of the total lesions studied. The average lesion size in our research was 1.46 cm with a standard deviation of 0.33. The size of most lesions ranged between 1 and 2 cm, while the smallest percentage were lesions whose size exceeded 2 cm. Recurrence occurred within 9 months in 42 cases out of 36 resected cases, a rate of 48.32%. We did not find a relationship between recurrence and age or diameter of the lesion, while there was a relationship between recurrence and the histological type, as most of the recurrent lesions were of the infiltrative, micronodular and fibrosin histological type. We found a relationship between recurrence and the proximity of neural structures, where 75% of cases adjacent to neural structures relapsed compared to 13.64% of cases not adjacent to neural structures, in addition to that there was a relationship between recurrence with long term sun exposure, and sun burns. Conclusion: Infiltrative, micronodular and fibrosin patterns, improper cutting edges, adjacent nerve structures, long term sun exposure, and sun burns are considered factors that predict recurrence in basal cell carcinoma tumors.

Keywords: Reconstructive surgery, basal cell carcinoma, recurrence, prognostic factors.