Purpose: Although basal cell carcinoma (BCC) is the most common form of skin cancer, locally advanced basal cell carcinoma of the head and neck is rare and not well studied. We examined oncologic outcomes following primary surgical treatment of these tumors.
Methods: We performed a retrospective review of patients who had undergone primary surgical resection of advanced head and neck basal cell carcinoma by head and neck surgeons at a tertiary academic center from 1998 – 2016.
Results: 85 patients with 101 tumors met inclusion criteria. 70% of patients were male and the mean age was 66. The most common subsite was the nose (24%), followed by the auricle (22%) and the periorbita (21%). 56% of tumors were recurrent with 53% having undergone prior surgical resection and 14% having undergone prior radiation. Frozen section or surgical margins were re-resected to negative margins in 30% of cases and 10% had positive final margins. Perineural invasion (PNI) was present in 21% of the cases and infiltrative tumors were the most common subtype (54%). Adjuvant radiation was administered in 21% of cases, primarily to those with positive margins or PNI. There were 21 recorded recurrences, which were primarily local (81%), and the majority of the local recurrences (88%) were succesfully salvaged with re-resection. There were four recorded BCC-related deaths, two from local recurrence and two from distant recurrence. The 5-year Kaplan-Meier estimated recurrence free survival (RFS) was 57.9%, overall survival (OS) was 79.9%, and disease-specific survival (DSS) was 96.5%. On Cox regression analysis, tumors with diameter > 2 cm were more likely to recur (p=0.05).
Conclusion: Locally advanced BCCs of the head and neck have high rates of intra-operative cut-through and local recurrence, indicative of their locally aggressive nature. Despite this, aggressive surgical management with re-resection and surgical salvage maintains a very low rate of mortality from this disease.