This correspondence describes a new technique for determining basal cell carcinoma (BCC) borders, to aid in obtaining clear peripheral resection margins. Whilst this can be straightforward in small well-defined nodular BCCs, some BCC subtypes are ill-defined or morphoeic, and resection margins may be compromised by underestimating the full extent of the lesion. Whilst Mohs micrographic surgery is a well-recognised technique for high-risk BCC in cosmetically sensitive sites, this technique is only available in certain centres. Existing techniques include the BCC stretch test, whereby stretching the skin empties the tumour microcirculation of erythrocytes, accentuating the characteristic pearlescent tumour border, or application of an alcohol wipe which accentuates the erythematous discolouration of the tumour and telangiectasia. This technique involves using a spoon or curette to curette the patient’s tumour and adjacent skin. The distinction between bleeding and non-bleeding adjacent skin can be used to define the macroscopic border of the tumour and facilitate more informed peripheral excision margin. The authors claim this is a useful technique to assist surgeons in obtaining clearer surgical margins in high-risk, ill-defined BCC. A blinded comparison of the various techniques, and the resulting peripheral margins obtained would be a useful next step to compare these techniques.

Achieving clear margins: Review of techniques to more accurately delineate basal cell carcinoma (BCC) macroscopic border prior to excision biopsy.
Nagrath N, Durrani A.
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Elinor Warner

MBBS MA (Oxon) MRCS DOHNS, Royal London Hospital; Vice-president WENTS, UK.

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