Evaluation of Surgical Outcomes and Recurrence Rates in Non- Melanoma Skin Cancers: a Single Center Retrospective Study

Evaluation of Surgical Outcomes and Recurrence Rates in Non- Melanoma Skin Cancers: a Single Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Surgical Outcomes and Recurrence Rates in Non- Melanoma Skin Cancers: a Single Center Retrospective Study Seyit Ahmet Korur, Ramazan Erkin Ünlü, Hasan Murat Ergani, Omercan Sahin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6280411/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Non-melanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common malignancies worldwide, particularly affecting the head and neck. BCC is locally invasive, while SCC carries a higher risk of metastasis. Surgical excision remains the primary treatment, and achieving clear histopathological margins is critical in minimizing recurrence. Objective : This study seeks to assess recurrence rates and surgical margin positivity in patients treated for non-melanoma skin cancer (NMSC) and to examine the correlation of these outcomes with age, gender, diagnosis, and lesion location. Methods : A retrospective analysis was conducted on 209 patients who underwent surgical excision for NMSC at Ankara Bilkent City Hospital between January 2022 and January 2023. Demographic data, diagnosis, surgical margins, and recurrence status were collected and evaluated over a one-year postoperative follow-up period. Results : There was no statistically significant association between local recurrence and lesion location, gender, or diagnosis. However, recurrence was significantly associated with older age (p < 0.05). Margin positivity was significantly related to diagnosis (p < 0.05), with higher rates observed in BCC patients. Logistic regression analysis confirmed diagnosis as an independent predictor of margin positivity. Among patients pre-diagnosed with BCC but pathologically confirmed with SCC, local recurrence was higher, likely due to inadequate excision margins. Conversely, patients initially diagnosed with SCC but pathologically confirmed with BCC had no recurrence. Conclusion : Both patient age and diagnosis are key predictors of recurrence and margin positivity in NMSC. In particular, cases of diagnostic discrepancy highlight the importance of accurate preoperative evaluation and appropriate surgical planning. Elderly patients and those with BCC require careful surgical consideration to ensure complete excision while balancing aesthetic outcomes. Non-melanoma skin cancer Surgical Margins Local Recurrence Plastic Surgery INTRODUCTION Non-melanoma skin cancers are the most common malignancies worldwide, affecting the head and neck region the most. Basal Cell Carcinoma (BCC) accounts for 75–80% of these cancers, Squamous Cell Carcinoma (SCC) comprises 20–25%, and rarely, Merkel Cell Carcinoma (MCC) represents less than 5%. While BCC is locally aggressive, SCC has a greater potential for metastasis. MCC is a neuroendocrine tumor characterized by elevated mortality rates and an unfavorable prognosis. The mechanism of skin carcinogenesis remains incompletely elucidated. ( 1 – 3 ) Numerous studies have been undertaken to elucidate the mechanisms that contribute to malignancy. As plastic surgeons, we must be proficient in managing this cancer. A variety of treatments are available for these tumors, such as phototherapy, radiation therapy, electrocryotherapy, brachytherapy, Mohs surgery, and topical agents; nevertheless, the primary treatment remains surgical excision ( 4 , 5 ). Non-melanoma skin cancers exhibit a low metastasis rate and favorable prognosis; specifically, basal cell carcinoma (BCC) has a metastasis rate of under 1% over five years, whereas squamous cell carcinoma (SCC) may range from 5–8%. A prior study established that the recurrence rates for non-melanoma skin cancer were 3.6% for basal cell carcinoma (BCC) and 3.4% for squamous cell carcinoma (SCC) at the 5-year follow-up post-treatment. ( 7 , 8 ) This study aims to gather data on the epidemiology of non-melanoma skin cancers and evaluate the rate of local recurrence following surgery, dependent on a positive margin on any side or a 1 mm surgical margin post-treatment. ( 8 ) MATERIALS AND METHODS This is a retrospective study carried out from March 2024 to April 2024. Patients diagnosed with non-melanoma skin cancer were observed in the outpatient clinic for one year following surgical intervention at Ankara Bilkent City Hospital. The study included patients who underwent surgery from January 2022 to January 2023. Data obtained from the hospital's database were acquired. Patients were evaluated according to archive number, first name, last name, gender, age, preliminary diagnosis, definitive diagnosis, pathology results, and recurrence. Patients with pre-diagnosed or diagnosed cancerous tissues underwent excision in the operating room under local or general anesthesia, ensuring a surgical margin of at least 5 mm, followed by reconstruction of the defects using skin grafts or local flaps. Patients were subsequently scheduled for follow-up evaluations at 1 month, 3 months, 6 months, and 1 year, during which they were assessed alongside the pathology results. Statistical Analysis Statistical analysis was conducted utilizing SPSS version 25.0 software (IBM Corp., Armonk, NY, USA). Descriptive statistics are presented as mean ± standard deviation (SD), median (range), or count and frequency, as applicable. Variables were assessed through chi-square and logistic regression analysis. The data is determined to be normally distributed. CONFLICTS OF INTEREST Undeclared. RESULTS The statistical analysis of this study revealed no statistically significant differences in local recurrence concerning lesion location (p = 0.823), patient gender (p = 0.645), or patient diagnosis (p = 0.549). Similarly, there is no significant distinction between local recurrence and positive surgical margins (p = 0.925). A statistically significant difference was observed between local recurrence and patient age (p < 0.05). About the surgical margin positivity, no significant difference was found between the location of the lesions (p = 0.925), gender of the patients (p = 0.607), or age of the patients (p = 0.463). In contrast, a significant difference was found between surgical margin positivity and the diagnosis received by the patients (p < 0.05). The logistic regression analysis demonstrated a statistically significant reduction in the likelihood of positive surgical margins associated with the patients' diagnosis (OR = 0.333, 95% CI [0.204, 0.543], p < 0.05), even when adjusting for gender and lesion location. The findings indicate that the patients' diagnosis serves as a predictor of surgical margin positivity, independent of other demographic and clinical variables. DISCUSSION Previous studies indicate that the gender distribution in non-melanoma skin cancers predominantly features male patients, with an average age of 70 years (59.2%). A separate study indicated that the majority were female (53%) (7, 8). This study's primary demographic consisted of males (51.2%), with a mean age of 69.5 years among participants. The findings of this study align with those of other research. Non-melanoma skin cancers predominantly occur on the face. In this study, it is also found that 91% of the patients' lesions were on the face, 6.22% on the upper extremity, 1.44% on the body, and 0.96% on the lower extremity. This phenomenon can be elucidated by prior research indicating that cancers are more prevalent in regions exposed to sunlight (9–11). No statistically significant difference was observed between the lesion locations and the patients' gender, diagnosis, or age. (p<0.05) Of the 163 patients pre-diagnosed with BCC, 110 (52.6%) were confirmed to have BCC, 21 (10.05%) were diagnosed with SCC, and 32 (15.3%) were identified with non-melanoma skin cancer. Among 39 patients pre-diagnosed with SCC, 22 (10.5%) were confirmed to have SCC, 8 (3.8%) were diagnosed with BCC, and 9 (4.3%) were identified with non-melanoma skin cancer. Seven patients were diagnosed with non-melanoma skin cancer; four (1.91%) were diagnosed with non-melanoma skin cancer, three (1.44%) with basal cell carcinoma (BCC), and none with squamous cell carcinoma (SCC). Local recurrence occurred in 1 (4.54%) of the 22 patients initially diagnosed with BCC, who were subsequently diagnosed with SCC following pathology results. In patients pre-diagnosed with BCC, where pathology results indicate SCC, excisions may be conducted without adequate surgical margins, potentially resulting in undesirable local recurrences. Another result corroborating this finding is that none of the eight patients pre-diagnosed with SCC, whose pathological results indicated BCC, experienced local recurrence. The outcome may indicate that in patients with SCC prior to diagnosis, excision of the masses with broader resection yields adequate margins for lesions with BCC pathology results.Studies indicate that the most prevalent tumors were basal cell carcinoma (BCC), with an incidence rate of 3.6%. In these studies, a surgical margin of 3.8 mm was established as the criterion, and some authors indicated that the recurrence rate of tumors could be diminished by securing broader surgical margins (7,8). The surgical margin criterion was 5.0, with local recurrence rates of 3.35% for basal cell carcinoma (BCC) and 1.91% for squamous cell carcinoma (SCC) after one year of follow-up. A statistically significant rise in local recurrence was observed in patients aged 75-99, while the incidence of local recurrence appeared to diminish in the age group of 25-74. (p<0.05). However, certain studies indicate that the recurrence rate correlates with tumor depth and is independent of age and gender (12–14). Among 12 patients with local recurrence, 83.33% of the lesions were located on the face, 16.67% on the upper extremity, and there were no lesions with local recurrence in the lower extremity. Surgeons refrain from making radical incisions in the facial region due to cosmetic standards, while no local recurrence was observed in the lower extremity, as incisions in these areas pose fewer aesthetic concerns. No statistically significant difference was noted among patients with positive margin status regarding lesion location, gender, and age. However, a statistically significant difference found between the patients with positive margin status and their diagnoses. (p<0.05). Among patients with positive margins, 74.65% were diagnosed with BCC and 23.9% with SCC; the incidence of positive margins was five times higher in patients with BCC compared to those with SCC. This indicates that 57.89% of the patients in this study were diagnosed with BCC, while only 20.57% were diagnosed with SCC. In patients with positive margins, inadequate excision is the predominant cause of local recurrence and margin positivity. Although local recurrence correlates with tumor characteristics and localization, it is also associated with the patient's age.(15,16) RESULTS Non-melanoma skin cancer is a concern that plastic surgeons and patients must approach with caution. Surgeons must exercise caution during lesion excision, and the patient should not disregard outpatient clinic follow-ups. Patients should be cognizant that 80% of individuals referred to the plastic surgery clinic with a pre-diagnosis of skin cancer subsequently received a confirmed diagnosis of skin cancer.Particularly elderly individuals should be cautioned that their diagnosis may arise during outpatient clinic follow-up.The primary objective should be to achieve clean surgical margins, rather than prioritizing the patient's cosmetic appearance. Declarations Data Availability Statement The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interest Statement The authors declare that they have no competing interests Author Contributions: Seyit Ahmet Korur: Study conception and design, data collection, data analysis and interpretation, drafting the manuscript. Ramazan Erkin Unlu: Critical revision of the manuscript, supervision, data collection, surgical procedures. Hasan Murat Ergani: Data interpretation, literature review, manuscript editing, surgical procedures. Omercan Sahin: Data collection, data analysis, contribution to discussion. All authors read and approved the final manuscript Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Consent to Participate Consent to Participate declaration: Not applicable Ethics Declaration Ethical approval for this study titled Evaluation of Surgical Outcomes and Recurrence Rates in Non-Melanoma Skin Cancers: A Single Center Retrospective Study was obtained from the 2nd Medical Research Scientific and Ethical Evaluation Committee (TABED) of Ankara Bilkent City Hospital (Approval Number: TABED-224-321, dated 10.07.2024).All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee and with the 1964 Helsinki Declaration and its later amendments. References Rampinelli V, Pinacoli A, Piazza C. Head and neck nonmelanoma skin cancers: surgical management and debated issues. Curr Opin Otolaryngol Head Neck Surg. 2024;32(2):62-70. Dachani SR, Kaleem M, Mujtaba MA, Mahajan N, Ali SA, Almutairy AF, et al. A comprehensive review of various therapeutic strategies for the management of skin cancer. ACS Omega. 2024;9(9):10030-10048. Didona D, Paolino G, Bottoni U, Cantisani C. Non-melanoma skin cancer pathogenesis overview. Biomedicines. 2018;6(1):6. Al-Qadasi N, Al-Sayaghi Y, Al-Tam A, Al-Fakih R. Nonmelanoma facial skin cancer: surgical planning for resection and reconstruction. Egyptian Journal of Surgery. 2024;43(2):398-406. Villani A, Potestio L, Lallas A. Editorial: new strategies for the treatment of advanced melanoma and non-melanoma skin cancer. Front Med (Lausanne). 2024;11:1366008. Ciuciulete AR, Stepan AE, Andreiana BC, Simionescu CE. Non-melanoma skin cancer: statistical associations between clinical parameters. Curr Health Sci J. 2022;48(1):110-5. Firnhaber JM. Diagnosis and treatment of basal cell and squamous cell carcinoma. Am Fam Physician. 2012;86(2):161-8. Chren MM, Torres JS, Stuart SE, Bertenthal D, Labrador RJ, Boscardin WJ. Recurrence after treatment of nonmelanoma skin cancer: a prospective cohort study. Arch Dermatol. 2011;147(5):540-6. Calzavara-Pinton P, Ortel B, Venturini M. Non-melanoma skin cancer, sun exposure and sun protection. G Ital Dermatol Venereol. 2015;150(4):369-78. Armstrong BK, Kricker A. The epidemiology of UV-induced skin cancer. J Photochem Photobiol B. 2001;63(1-3):8-18. Garbe C, Forsea AM, Amaral T, Arenberger P, Autier P, Berwick M, et al. Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them. Eur J Cancer. 2024;204:114074. Domínguez-Cherit J, Rodríguez-Gutiérrez G, Narváez Rosales V, Toussaint Caire S, Fonte Avalos V. (Characteristics and risk factors for recurrence of cutaneous squamous cell carcinoma with conventional surgery and surgery with delayed intraoperative margin assessment). Cir Cir. 2017;85(6):499-503. Khan L, Breen D, Zhang L, Balogh J, Czarnota G, Lee J, et al. Predictors of recurrence after radiotherapy for non-melanoma skin cancer. Curr Oncol. 2014;21(2):e326-9. Farberg AS, Heysek RV, Haber R, Agha R, Crawford KM, Xinge J, et al. Freedom from recurrence across age in non-melanoma skin cancer treated with image-guided superficial radiation therapy. Geriatrics. 2024;9(5):114. Genders RE, Marsidi N, Michi M, Henny EP, Goeman JJ, van Kester MS. Incomplete excision of cutaneous squamous cell carcinoma: systematic review of the literature. Acta Derm Venereol. 2020;100(6):1-8. Durmuş Kocaaslan FN, Alakuş AC, Sacak B, Çelebiler O. Evaluation of residual tumors and recurrence rates of malignant melanoma and non-melanoma skin cancer of head and neck region. Marmara Medical Journal. 2019;32(3):107-11. Tables Tables 1 to 19 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files TABLESOnlyEnglishWithTables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6280411","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443324428,"identity":"da928b1a-9d2e-46c4-ad8d-8afccac4e53e","order_by":0,"name":"Seyit Ahmet Korur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYJCCA2DEwAbmyLExMDfAOLi1HABpYYOoMmZjYCSshQFZS2IDIS3y7T2Ghz/U3Inml29LfFzZdi+9j/1g42OeMgZ5frEDWLUYnDljcODAsWe5M9vYDhuebSvObeNJbDbmOcdgOHN2AnYtEjlALWyHczccY2+TbGxLyG2TYGyT5m1jSDC4jV2L/Pw3QC3/Dufuh2pJZyOkheEGj8GBg21AW9jYjoG0JBDUYnAmreDA2b7DuTOOpSUbNpxLMAT5xXDOOQmcfpFvP7z5Q8W3w7n9zccMHzaUJcgDRQ4+eFNmI88vjcNhDBwGWIUlcCgHAfYHeCRHwSgYBaNgFAABAMsOZQP2XUlvAAAAAElFTkSuQmCC","orcid":"","institution":"Ankara Bilkent City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Seyit","middleName":"Ahmet","lastName":"Korur","suffix":""},{"id":443324429,"identity":"32938e2f-a941-4b4b-8d7f-d6ed27110171","order_by":1,"name":"Ramazan Erkin Ünlü","email":"","orcid":"","institution":"Ankara Bilkent City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ramazan","middleName":"Erkin","lastName":"Ünlü","suffix":""},{"id":443324430,"identity":"0470b53c-6301-4413-9271-b7ffc5bc832c","order_by":2,"name":"Hasan Murat Ergani","email":"","orcid":"","institution":"Ankara Bilkent City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"Murat","lastName":"Ergani","suffix":""},{"id":443324431,"identity":"16d45b85-c8fc-4189-9dfa-a4450606d816","order_by":3,"name":"Omercan Sahin","email":"","orcid":"","institution":"Ankara Bilkent City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Omercan","middleName":"","lastName":"Sahin","suffix":""}],"badges":[],"createdAt":"2025-03-21 22:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6280411/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6280411/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80694740,"identity":"32b8d877-77f3-4b4b-83e6-0a1feee6fc2f","added_by":"auto","created_at":"2025-04-16 06:34:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479953,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6280411/v1/3022c218-231b-4004-96f7-72fdf3ad5ff9.pdf"},{"id":80692686,"identity":"c02ee986-4418-45b1-b978-84b7a9ac0a76","added_by":"auto","created_at":"2025-04-16 06:02:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":199242,"visible":true,"origin":"","legend":"","description":"","filename":"TABLESOnlyEnglishWithTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6280411/v1/94e7312ea5aedf94ea7e8a11.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of Surgical Outcomes and Recurrence Rates in Non- Melanoma Skin Cancers: a Single Center Retrospective Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNon-melanoma skin cancers are the most common malignancies worldwide, affecting the head and neck region the most. Basal Cell Carcinoma (BCC) accounts for 75\u0026ndash;80% of these cancers, Squamous Cell Carcinoma (SCC) comprises 20\u0026ndash;25%, and rarely, Merkel Cell Carcinoma (MCC) represents less than 5%. While BCC is locally aggressive, SCC has a greater potential for metastasis. MCC is a neuroendocrine tumor characterized by elevated mortality rates and an unfavorable prognosis. The mechanism of skin carcinogenesis remains incompletely elucidated. (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Numerous studies have been undertaken to elucidate the mechanisms that contribute to malignancy. As plastic surgeons, we must be proficient in managing this cancer. A variety of treatments are available for these tumors, such as phototherapy, radiation therapy, electrocryotherapy, brachytherapy, Mohs surgery, and topical agents; nevertheless, the primary treatment remains surgical excision (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Non-melanoma skin cancers exhibit a low metastasis rate and favorable prognosis; specifically, basal cell carcinoma (BCC) has a metastasis rate of under 1% over five years, whereas squamous cell carcinoma (SCC) may range from 5\u0026ndash;8%. A prior study established that the recurrence rates for non-melanoma skin cancer were 3.6% for basal cell carcinoma (BCC) and 3.4% for squamous cell carcinoma (SCC) at the 5-year follow-up post-treatment. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e This study aims to gather data on the epidemiology of non-melanoma skin cancers and evaluate the rate of local recurrence following surgery, dependent on a positive margin on any side or a 1 mm surgical margin post-treatment. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis is a retrospective study carried out from March 2024 to April 2024. Patients diagnosed with non-melanoma skin cancer were observed in the outpatient clinic for one year following surgical intervention at Ankara Bilkent City Hospital. The study included patients who underwent surgery from January 2022 to January 2023. Data obtained from the hospital\u0026apos;s database were acquired. Patients were evaluated according to archive number, first name, last name, gender, age, preliminary diagnosis, definitive diagnosis, pathology results, and recurrence. Patients with pre-diagnosed or diagnosed cancerous tissues underwent excision in the operating room under local or general anesthesia, ensuring a surgical margin of at least 5 mm, followed by reconstruction of the defects using skin grafts or local flaps. Patients were subsequently scheduled for follow-up evaluations at 1 month, 3 months, 6 months, and 1 year, during which they were assessed alongside the pathology results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted utilizing SPSS version 25.0 software (IBM Corp., Armonk, NY, USA). Descriptive statistics are presented as mean \u0026plusmn; standard deviation (SD), median (range), or count and frequency, as applicable. Variables were assessed through chi-square and logistic regression analysis. The data is determined to be normally distributed.\u003c/p\u003e\n\u003cp\u003eCONFLICTS OF INTEREST\u003c/p\u003e\n\u003cp\u003eUndeclared.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe statistical analysis of this study revealed no statistically significant differences in local recurrence concerning lesion location (p = 0.823), patient gender (p = 0.645), or patient diagnosis (p = 0.549). Similarly, there is no significant distinction between local recurrence and positive surgical margins (p = 0.925). A statistically significant difference was observed between local recurrence and patient age (p \u0026lt; 0.05). About the surgical margin positivity, no significant difference was found between the location of the lesions (p = 0.925), gender of the patients (p = 0.607), or age of the patients (p = 0.463). In contrast, a significant difference was found between surgical margin positivity and the diagnosis received by the patients (p \u0026lt; 0.05). The logistic regression analysis demonstrated a statistically significant reduction in the likelihood of positive surgical margins associated with the patients\u0026apos; diagnosis (OR = 0.333, 95% CI [0.204, 0.543], p \u0026lt; 0.05), even when adjusting for gender and lesion location. The findings indicate that the patients\u0026apos; diagnosis serves as a predictor of surgical margin positivity, independent of other demographic and clinical variables.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePrevious studies indicate that the gender distribution in non-melanoma skin cancers predominantly features male patients, with an average age of 70 years (59.2%). A separate study indicated that the majority were female (53%) (7, 8). This study\u0026apos;s primary demographic consisted of males (51.2%), with a mean age of 69.5 years among participants. The findings of this study align with those of other research. Non-melanoma skin cancers predominantly occur on the face. In this study, it is also found that 91% of the patients\u0026apos; lesions were on the face, 6.22% on the upper extremity, 1.44% on the body, and 0.96% on the lower extremity. This phenomenon can be elucidated by prior research indicating that cancers are more prevalent in regions exposed to sunlight (9\u0026ndash;11). No statistically significant difference was observed between the lesion locations and the patients\u0026apos; gender, diagnosis, or age. (p\u0026lt;0.05) Of the 163 patients pre-diagnosed with BCC, 110 (52.6%) were confirmed to have BCC, 21 (10.05%) were diagnosed with SCC, and 32 (15.3%) were identified with non-melanoma skin cancer. Among 39 patients pre-diagnosed with SCC, 22 (10.5%) were confirmed to have SCC, 8 (3.8%) were diagnosed with BCC, and 9 (4.3%) were identified with non-melanoma skin cancer.\u003c/p\u003e\n\u003cp\u003eSeven patients were diagnosed with non-melanoma skin cancer; four (1.91%) were diagnosed with non-melanoma skin cancer, three (1.44%) with basal cell carcinoma (BCC), and none with squamous cell carcinoma (SCC). Local recurrence occurred in 1 (4.54%) of the 22 patients initially diagnosed with BCC, who were subsequently diagnosed with SCC following pathology results.\u003c/p\u003e\n\u003cp\u003eIn patients pre-diagnosed with BCC, where pathology results indicate SCC, excisions may be conducted without adequate surgical margins, potentially resulting in undesirable local recurrences. Another result corroborating this finding is that none of the eight patients pre-diagnosed with SCC, whose pathological results indicated BCC, experienced local recurrence. The outcome may indicate that in patients with SCC prior to diagnosis, excision of the masses with broader resection yields adequate margins for lesions with BCC pathology results.Studies indicate that the most prevalent tumors were basal cell carcinoma (BCC), with an incidence rate of 3.6%. In these studies, a surgical margin of 3.8 mm was established as the criterion, and some authors indicated that the recurrence rate of tumors could be diminished by securing broader surgical margins (7,8). The surgical margin criterion was 5.0, with local recurrence rates of 3.35% for basal cell carcinoma (BCC) and 1.91% for squamous cell carcinoma (SCC) after one year of follow-up. A statistically significant rise in local recurrence was observed in patients aged 75-99, while the incidence of local recurrence appeared to diminish in the age group of 25-74. (p\u0026lt;0.05). However, certain studies indicate that the recurrence rate correlates with tumor depth and is independent of age and gender (12\u0026ndash;14). Among 12 patients with local recurrence, 83.33% of the lesions were located on the face, 16.67% on the upper extremity, and there were no lesions with local recurrence in the lower extremity. Surgeons refrain from making radical incisions in the facial region due to cosmetic standards, while no local recurrence was observed in the lower extremity, as incisions in these areas pose fewer aesthetic concerns. No statistically significant difference was noted among patients with positive margin status regarding lesion location, gender, and age. However, a statistically significant difference found between the patients with positive margin status and their diagnoses. (p\u0026lt;0.05). Among patients with positive margins, 74.65% were diagnosed with BCC and 23.9% with SCC; the incidence of positive margins was five times higher in patients with BCC compared to those with SCC. This indicates that 57.89% of the patients in this study were diagnosed with BCC, while only 20.57% were diagnosed with SCC.\u003c/p\u003e\n\u003cp\u003eIn patients with positive margins, inadequate excision is the predominant cause of local recurrence and margin positivity. Although local recurrence correlates with tumor characteristics and localization, it is also associated with the patient\u0026apos;s age.(15,16)\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eNon-melanoma skin cancer is a concern that plastic surgeons and patients must approach with caution. Surgeons must exercise caution during lesion excision, and the patient should not disregard outpatient clinic follow-ups. Patients should be cognizant that 80% of individuals referred to the plastic surgery clinic with a pre-diagnosis of skin cancer subsequently received a confirmed diagnosis of skin cancer.Particularly elderly individuals should be cautioned that their diagnosis may arise during outpatient clinic follow-up.The primary objective should be to achieve clean surgical margins, rather than prioritizing the patient\u0026apos;s cosmetic appearance.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeyit Ahmet Korur: Study conception and design, data collection, data analysis and interpretation, drafting the manuscript.\u003cbr\u003e\u0026nbsp;Ramazan Erkin Unlu: Critical revision of the manuscript, supervision, data collection, surgical procedures.\u003cbr\u003e\u0026nbsp;Hasan Murat Ergani: Data interpretation, literature review, manuscript editing, surgical procedures.\u003cbr\u003e\u0026nbsp;Omercan Sahin: Data collection, data analysis, contribution to discussion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to Participate declaration: Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study titled Evaluation of Surgical Outcomes and Recurrence Rates in Non-Melanoma Skin Cancers: A Single Center Retrospective Study was obtained from the 2nd Medical Research Scientific and Ethical Evaluation Committee (TABED) of Ankara Bilkent City Hospital (Approval Number: TABED-224-321, dated 10.07.2024).All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRampinelli V, Pinacoli A, Piazza C. Head and neck nonmelanoma skin cancers: surgical management and debated issues. \u003cstrong\u003eCurr Opin Otolaryngol Head Neck Surg.\u003c/strong\u003e 2024;32(2):62-70.\u003c/li\u003e\n \u003cli\u003eDachani SR, Kaleem M, Mujtaba MA, Mahajan N, Ali SA, Almutairy AF, \u003cem\u003eet al.\u003c/em\u003e A comprehensive review of various therapeutic strategies for the management of skin cancer. \u003cstrong\u003eACS Omega.\u003c/strong\u003e 2024;9(9):10030-10048.\u003c/li\u003e\n \u003cli\u003eDidona D, Paolino G, Bottoni U, Cantisani C. Non-melanoma skin cancer pathogenesis overview. \u003cstrong\u003eBiomedicines.\u003c/strong\u003e2018;6(1):6.\u003c/li\u003e\n \u003cli\u003eAl-Qadasi N, Al-Sayaghi Y, Al-Tam A, Al-Fakih R. Nonmelanoma facial skin cancer: surgical planning for resection and reconstruction. \u003cstrong\u003eEgyptian Journal of Surgery.\u003c/strong\u003e 2024;43(2):398-406.\u003c/li\u003e\n \u003cli\u003eVillani A, Potestio L, Lallas A. Editorial: new strategies for the treatment of advanced melanoma and non-melanoma skin cancer. \u003cstrong\u003eFront Med (Lausanne).\u003c/strong\u003e 2024;11:1366008.\u003c/li\u003e\n \u003cli\u003eCiuciulete AR, Stepan AE, Andreiana BC, Simionescu CE. Non-melanoma skin cancer: statistical associations between clinical parameters. \u003cstrong\u003eCurr Health Sci J.\u003c/strong\u003e 2022;48(1):110-5.\u003c/li\u003e\n \u003cli\u003eFirnhaber JM. Diagnosis and treatment of basal cell and squamous cell carcinoma. \u003cstrong\u003eAm Fam Physician.\u003c/strong\u003e2012;86(2):161-8.\u003c/li\u003e\n \u003cli\u003eChren MM, Torres JS, Stuart SE, Bertenthal D, Labrador RJ, Boscardin WJ. Recurrence after treatment of nonmelanoma skin cancer: a prospective cohort study. \u003cstrong\u003eArch Dermatol.\u003c/strong\u003e 2011;147(5):540-6.\u003c/li\u003e\n \u003cli\u003eCalzavara-Pinton P, Ortel B, Venturini M. Non-melanoma skin cancer, sun exposure and sun protection. \u003cstrong\u003eG Ital Dermatol Venereol.\u003c/strong\u003e 2015;150(4):369-78.\u003c/li\u003e\n \u003cli\u003eArmstrong BK, Kricker A. The epidemiology of UV-induced skin cancer. \u003cstrong\u003eJ Photochem Photobiol B.\u003c/strong\u003e 2001;63(1-3):8-18.\u003c/li\u003e\n \u003cli\u003eGarbe C, Forsea AM, Amaral T, Arenberger P, Autier P, Berwick M, \u003cem\u003eet al.\u003c/em\u003e Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them. \u003cstrong\u003eEur J Cancer.\u003c/strong\u003e 2024;204:114074.\u003c/li\u003e\n \u003cli\u003eDom\u0026iacute;nguez-Cherit J, Rodr\u0026iacute;guez-Guti\u0026eacute;rrez G, Narv\u0026aacute;ez Rosales V, Toussaint Caire S, Fonte Avalos V. \u003cem\u003e(Characteristics and risk factors for recurrence of cutaneous squamous cell carcinoma with conventional surgery and surgery with delayed intraoperative margin assessment).\u003c/em\u003e \u003cstrong\u003eCir Cir.\u003c/strong\u003e 2017;85(6):499-503.\u003c/li\u003e\n \u003cli\u003eKhan L, Breen D, Zhang L, Balogh J, Czarnota G, Lee J, \u003cem\u003eet al.\u003c/em\u003e Predictors of recurrence after radiotherapy for non-melanoma skin cancer. \u003cstrong\u003eCurr Oncol.\u003c/strong\u003e 2014;21(2):e326-9.\u003c/li\u003e\n \u003cli\u003eFarberg AS, Heysek RV, Haber R, Agha R, Crawford KM, Xinge J, \u003cem\u003eet al.\u003c/em\u003e Freedom from recurrence across age in non-melanoma skin cancer treated with image-guided superficial radiation therapy. \u003cstrong\u003eGeriatrics.\u003c/strong\u003e 2024;9(5):114.\u003c/li\u003e\n \u003cli\u003eGenders RE, Marsidi N, Michi M, Henny EP, Goeman JJ, van Kester MS. Incomplete excision of cutaneous squamous cell carcinoma: systematic review of the literature. \u003cstrong\u003eActa Derm Venereol.\u003c/strong\u003e 2020;100(6):1-8.\u003c/li\u003e\n \u003cli\u003eDurmuş Kocaaslan FN, Alakuş AC, Sacak B, \u0026Ccedil;elebiler O. Evaluation of residual tumors and recurrence rates of malignant melanoma and non-melanoma skin cancer of head and neck region. \u003cstrong\u003eMarmara Medical Journal.\u003c/strong\u003e2019;32(3):107-11.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 19 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Non-melanoma skin cancer, Surgical Margins, Local Recurrence, Plastic Surgery","lastPublishedDoi":"10.21203/rs.3.rs-6280411/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6280411/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cbr\u003e\nNon-melanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common malignancies worldwide, particularly affecting the head and neck. BCC is locally invasive, while SCC carries a higher risk of metastasis. Surgical excision remains the primary treatment, and achieving clear histopathological margins is critical in minimizing recurrence. \u003cbr\u003e\n\u003cstrong\u003eObjective\u003c/strong\u003e:\u003cbr\u003e\nThis study seeks to assess recurrence rates and surgical margin positivity in patients treated for non-melanoma skin cancer (NMSC) and to examine the correlation of these outcomes with age, gender, diagnosis, and lesion location. \u003cbr\u003e\n\u003cstrong\u003eMethods\u003c/strong\u003e:\u003cbr\u003e\nA retrospective analysis was conducted on 209 patients who underwent surgical excision for NMSC at Ankara Bilkent City Hospital between January 2022 and January 2023. Demographic data, diagnosis, surgical margins, and recurrence status were collected and evaluated over a one-year postoperative follow-up period. \u003cbr\u003e\n\u003cstrong\u003eResults\u003c/strong\u003e:\u003cbr\u003e\nThere was no statistically significant association between local recurrence and lesion location, gender, or diagnosis. However, recurrence was significantly associated with older age (p \u0026lt; 0.05). Margin positivity was significantly related to diagnosis (p \u0026lt; 0.05), with higher rates observed in BCC patients. Logistic regression analysis confirmed diagnosis as an independent predictor of margin positivity. Among patients pre-diagnosed with BCC but pathologically confirmed with SCC, local recurrence was higher, likely due to inadequate excision margins. Conversely, patients initially diagnosed with SCC but pathologically confirmed with BCC had no recurrence. \u003cbr\u003e\n\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003cbr\u003e\nBoth patient age and diagnosis are key predictors of recurrence and margin positivity in NMSC. In particular, cases of diagnostic discrepancy highlight the importance of accurate preoperative evaluation and appropriate surgical planning. Elderly patients and those with BCC require careful surgical consideration to ensure complete excision while balancing aesthetic outcomes.\u003c/p\u003e","manuscriptTitle":"Evaluation of Surgical Outcomes and Recurrence Rates in Non- Melanoma Skin Cancers: a Single Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 06:02:28","doi":"10.21203/rs.3.rs-6280411/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f33923f0-67b6-4fe5-bd0b-253585b8eedc","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-16T06:02:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-16 06:02:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6280411","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6280411","identity":"rs-6280411","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}