Effectiveness

No large randomised controlled trial (RCT) has compared the effectiveness of surgical excision with any other treatment modality . No RCT has compared predetermined margin widths for the surgical removal of SCC.

Several case series demonstrate an excellent clearance of SCC lesions with surgical excision. Freeman et a/.30 reported 91 surgically excised SCC, with a follow up ranging from 1 to 5 years. Metastases developed in three of the 91 patients. The authors did not note the size or location of the tumours. For SCC less than 2 cm in diameter, surgical excision resulted in a 5-year cure rate of 96% (22 of 23 patients). For lesions greater than 2 cm, 83% (10 of 12) of patients were free of disease 5 years later.

While many authors report high cure rates for excision, with variable follow up, the recommendations for the width of the excision margin has ranged from 4 mm to 1 cm. In one prospective study, 141 SCC lesions were excised with incremental 1 mm margins and subclinical extension of tumours was examined using frozen tissue sectioning via Mohs' micrographic surgery (MMS).31 With 4 mm surgical margins tumours less than 2 cm had a greater than 95% clearance, while tumours greater than 2 cm required at least 6 mm excision margins to achieve a greater than 95% clearance.

What are the effective therapeutic interventions for localised invasive SCC of the skin? How do the effective therapeutic interventions for SCC compare with each other? How do the cosmetic outcomes for these interventions compare?

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