Diagnosis, treatment and follow-up control in 124 patients with basal cell carcinoma of the maxillofacial region treated from 1992 to 1997

AIM: The aim of this study was to analyze diagnostic and therapeutic procedures and the outcome of patients treated for the most common malignant tumor of the facial skin, basal cell carcinoma.

PATIENTS AND METHODS: The files of patients with basal cell carcinoma (BCC) treated over a period of 6 years were evaluated. Emphasis was placed on the frequency of second interventions, local recurrences and histological subtyping of tumors.

RESULTS: One-hundred and twenty-four patients were treated for 216 basal cell carcinomas (solitary: 67%, multiple: 33%). The tumors were predominantly located in the skin covering the middle third of the face. The tumors were 30 mm or less in diameter in 86%. Treatment was exclusively surgical. Histopathological subtyping revealed solid (83%), sclerodermiform (10%), metatypical (4%) and multicentric (3%) tumors. Resection of adjacent bone was mandatory in 12 patients and orbital exenteration in 2. Further local resections were necessary after thorough histological investigation in 71% of patients. Local recurrences occurred in 14 patients, predominantly within the first year after ablative surgery. Relative to the small number of sclerodermiform BCC, this subtype was the most frequent tumor that developed local recurrences.

CONCLUSION: Basal cell carcinoma is a malignant tumor, slowly growing and often showing wide extension to macroscopically non-affected sites. Resection of tumors is delicate in the maxillofacial region due to the predilection for sites of origin adjacent to structures of eminent importance for facial appearance. The sclerodermiform subtype is prone to local recurrence and these patients should be followed up carefully.