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Basal Cell Carcinoma — SCE Dermatology MCQ

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HardDermatological SurgeryBasal Cell CarcinomaSCE Dermatology

A nodular basal cell carcinoma on the nose has been excised with histologically clear but very close lateral and deep margins. What is the most appropriate next management principle?

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Correct answer: E — Risk-stratify close clear margins before deciding on further treatment

The best answer is “Risk-stratify close clear margins before deciding on further treatment”. A close margin is not the same as tumour at the margin. Site, subtype, measured clearance, patient factors and feasibility of further surgery determine whether surveillance, re-excision or margin-controlled surgery is proportionate. The alternatives “Offer margin-controlled re-excision after specialist risk review”, “Offer standard wider re-excision after specialist risk review”, “Use structured clinical surveillance when further surgery is disproportionate”, “Consider radiotherapy when surgery is unsuitable and recurrence risk warrants it” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: BAD basal cell carcinoma guideline 2021: https://academic.oup.com/bjd/article/185/5/899/6599942