To the Editor.—
Wolf and Zitelli1 recommend excising a 4-mm margin of normal-appearing skin surrounding basal cell epitheliomas (BCEs), based on histologic studies utilizing Mohs surgery to track strands and/or nests of BCEs under light microscopy. However, the significance of the histologic adequacy of the excised margin has been a puzzle in terms of clinical recurrence; patients with histologic evidence of an incompletely removed BCE have a risk of aggressive tumor recurrence.2-4 Nevertheless, it is also known that the rate of recurrence is only a third in cases with a histologically positive margin.3,5 In the remaining cases, residual tumors either disappeared6 or did not recur.3,5,7 On the other hand, a fairly large number2 of recurrent BCEs have been considered to be adequately excised when examined histologically. Consequently, a more detailed study of the growth behavior of BCEs was deemed necessary in order to explain
Imayama S. Morphologic Basis for Adequate Surgical Excision of Basal Cell Epitheliomas. Arch Dermatol. 1988;124(11):1715–1716. doi:10.1001/archderm.1988.01670110071017
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