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Basal cell carcinoma margins

Posted by

I have had a nodular basal cell carcinoma removed and the pathology report says the biopsy showed the cancer was 1mm from margin.

The consultant has told me i am clear and there is no need for further treatment or checks.

Everything i have read implies they like a clear margin of 3 to 4mm.

What is your opinion?

Kind regards

Colin <Edit by admin>

Ellen M-Macmillan
Posted by

Hi Coly,

Thanks for getting back in touch with us.

It’s natural to worry when you’re reading one thing about your excision margin and you feel that your consultant is telling you something else.

You’re right that guidelines do suggest that the risk of recurrence for a primary Basal cell carcinoma (BCC) decreases the greater the surgical margin is. But if someone has a complete excision a =>1mm margin is still considered adequate for patients with a first primary BCC.

These guidelines say that for a primary BCC, a 3mm peripheral surgical margin will clear the tumour in 85% of cases, and a 4-5 mm margin will increase the peripheral clearance rate to approximately 95%.

But the risk of recurrence seems highest in lesions where both lateral and deep margins were involved.

However, sometimes it’s not always possible to do further surgery and the guidelines about follow up state:

Patients with a first primary BCC who have had complete excision with adequate margins (= >1mm) or adequate treatment with PDT or radiotherapy should be given appropriate written advice on how to monitor for local recurrence and how to check for new primary BCCs and discharged from secondary care with no required GP follow-up (F/U).”

We would suggest that you go back and speak to you consultant again about your concerns. If after speaking to your doctor and you still don’t feel happy, then you can ask for a second opinion. If both doctors are in agreement about your diagnosis and treatment then this can help you to feel more confident about the decisions that have been made.

Sometimes it can be helpful to talk to others in a similar situation. If you think that would be helpful to do, we have a supportive skin cancer group that you can join.

Or, if you felt it would help to talk to one of our nurses on the phone you can call our Support Line on 0808-808-0000. We are open Monday to Friday 9am till 8pm.

Best wishes and take care.

Ellen-Macmillan Online Digital Nurse Specialist.