Incomplete excision of non-melanoma skin cancer of the head
and neck: can we predict failure?
Ulrik Knap Kjerkegaard
Lars Bjorn Stolle
Received: 22 October 2013 /Accepted: 7 December 2013 /Published online: 10 January 2014
Springer-Verlag Berlin Heidelberg 2014
Background Reported incomplete excision rates vary widely.
This study described a single center's treatment of basal cell
carcinoma (BCC) and squamous cell carcinomas (SCC) of the
head and neck and investigated possible causes of incomplete
Methods All excised BCCs and SCCs in 2011 were included
into the study. Patients were identified by the diagnostic
(diagnosis-related group (DRG)) codes from DC44.0 to
DC44.4. A total of 437 patients were treated for 516 skin
Results Mean age was 71.4 years and the male–female ratio
was 1.29. Incomplete tumor removal was found in 11 % of all
cases. Four significant factors were identified to predict in-
complete excision, including age >75 years (relative risk
(RR)=14.8 % (95 %-CI: 5.8–24.7 %)), BCC tumor size above
1.5 cm (RR=17.1 % (95 %-CI: 3.7–28.7 %)), lack of suffi-
cient excision margin in SCC (<6 mm) (RR=17.1 % (95 %-
CI: 0.1–36.9 %)) and lack of frozen sectioning in high-risk
areas (RR=16.9 % (95 %-CI: 7.5–27.2 %)). Neither gender,
tumor type, histological subtype, biopsy prior to surgery,
tumor location nor surgeon grade predicted incomplete
Conclusions Head and neck BCCs, and SCCs are difficult to
treat, and the need for complete tumor excision is mandatory
prior to reconstruction. Our findings showed that causes of
incomplete excision could be identified. With this knowledge,
we are able to optimize our quality of treatment, patient
satisfaction, and finally, the cost/effectiveness of our
Level of Evidence: Level III, prognostic/risk study.
Keywords Headand neck non-melanoma skincancer
The rising incidence of basal cell carcinoma (BCC) and squa-
mous cell carcinoma (SCC) has both clinical and financial
implication. The optimal clinical task is complete excision of
the tumor. However, incomplete excision is reported in be-
tween 4 and 25 % of the patients. When the tumor is incom-
pletely excised, surgical re-excision is recommended [1–3].
The total amount of head and neck non-melanoma skin
cancer (NMSC) is a challenging problem in our health system
[4, 5]. Fortuin et al.  used internal audits to improve quality
and cost/effectiveness of BCC excisions. They reported a
decrease in incomplete excised tumors from 16 to 7 % during
2005–2010, and an analysis of possible causes was done.
Attempts are constantly made to increase the quality and
effectiveness of our treatment, but are we able to predict
incomplete excision? Potential risk factors may be identified
retrospectively, and thus, upcoming data could be helpful in
planning our health care system.
A recently published study by this research group describes
the epidemiology of NMSCs treated at a single center of
plastic surgery in Denmark including all BCCs and SCCs
. This study serves as basis for the current study, in which
the main focus is to describe incomplete excision of NMSC of
the head and neck region.
In the current study we aim to identify possible risk factors
contributing to incomplete excision.
U. K. Kjerkegaard
Department of Plastic Surgery, Plastic Surgery Research Unit,
Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C,
L. B. Stolle (*)
Department of Plastic Surgery, Aarhus University Hospital,
Norrebrogade 44, 8000 Aarhus C, Denmark
Eur J Plast Surg (2014) 37:141–146