Risk Factors for the Recurrence of Basal Cell Carcinomas with Special Remarks on the R-Status

Background: Surgical excision remains the gold standard in the treatment of operable basal cell carcinoma (BCC). According to national guidelines, total resection with tumor-free margins should always be achieved in order to avoid recurrence. The aim of this study was to investigate surgical, histological as well as tumorspecific risk factors for the recurrence of BCC of the head and neck. Materials and Methods: In a retrospective analysis, patients who were operated on because of a BCC of the head and neck between 2011 and 2014 were included. Epidemiological as well as therapeutic and histological data were collected and investigated concerning the recurrence of the tumor. Follow-up data were controlled for recurrence. Results: 141 patients with a mean age of 72.9 years were included in this study. Most frequent tumor localizations were the nose and temple, and most of the BCC were nodular. Altogether, 8.6% of the patients showed a recurrence. In the chi-squared analysis, R-status or the resection margin did not correlate with the risk of BCC recurrence at the same localization. In contrast, the significant risk factors for recurrence were the tumor localization, size, and histological subtype. Conclusion: Incomplete total resection (R1) of a BCC does not inevitably lead to a recurrence. A reason therefore might be immune-mediated regression, which can be seen in other tumor entities as well. However, a total resection should still always be the aim for surgical therapy, especially for cases with high risk for recurrence.