Basal Cell Carcinoma — SCE Dermatology MCQ

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ModerateSkin CancerBasal Cell CarcinomaSCE Dermatology

A 65-year-old man has a BCC incompletely excised — the lateral margin is involved but the deep margin is clear. The BCC is nodular subtype on the trunk. What is the recommended management?

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Correct answer: B — Re-excision of the involved margin or Mohs surgery

Incomplete excision of BCC (tumour at the margin) requires further treatment. For incompletely excised nodular BCC with an involved lateral margin and clear deep margin, BAD guidelines recommend re-excision (of the affected margin with adequate clearance) or Mohs micrographic surgery. The decision depends on BCC subtype, site, and patient factors. Recurrence rates after incomplete excision range from 17-41% over 5 years without further treatment. Radiotherapy is an alternative when surgery is not feasible. Observation alone is generally only considered in specific circumstances (e.g., elderly/comorbid patients with superficial BCC and involved peripheral margin at low-risk sites after MDT discussion).

Reference: BAD 2021 BCC Guidelines; NICE