面部基底细胞癌258例临床分析

Clinical Analysis of 258 Cases of Facial Basal Cell Carcinoma

目的:探讨面部基底细胞癌(basal cell carcinoma,BCC)的常见临床特征,包括流行病学、临床表现、诊断方法与治疗手段等,为提高临床对面部BCC的诊治能力提供依据。方法:对本科室2014年1月至2018年9月收治的面部BCC患者资料进行回顾总结,分析患者的年龄、职业、病程、皮损分布、肿瘤形态、诊断过程、治疗方式及预后等因素。结果:面部BCC好发于60岁以上的老年患者(74.4%),其中57.4%为长期户外工作者,曝光部位占68.8%,97.3%为单发。就诊时平均病程(22.7±6.9)月,溃疡型最常见(28.2%)。89.8%的患者在首次就诊即可确诊,皮肤镜对诊断具有重要价值,但误(漏)诊率并不低(21.1%)。手术切除仍为最主要的治疗方式(91.0%),其中86.4%在切除后采用邻位皮瓣修复创面。手术切除的一次性治愈率达93.8%,配合术中多点冰冻和Mohs显微描记可提高对切除完整性的判断。结论:面部BCC因早期病情隐匿,进展慢,易被忽视。皮肤镜可提高面部BCC的诊断正确率,但仍应以组织病理检查作为金标准。术前经验性地确定手术切除的边界可以保证一定的切净率,但若有条件,仍应充分结合术中多点冰冻或Mohs显微描记来提高手术准确度。

Objective: To explore the clinical characteristics of facial basal cell carcinoma(BCC), including epidemiology, clinical manifestations, diagnosis and treatment methods, etc., and provide a basis for its clinical improvement on the diagnosis and treatment. Methods: Retrospective analysis was performed on facial BCC patients admitted in our department from January 2014 to September 2018. Age, occupation, course of disease, lesion distribution, tumor morphology, diagnosis process, treatment method and prognosis were analyzed. Results: Facial BCC commonly occurred in patients over 60 years(74.3%) and outdoor workers(57.4%), and usually in sun-exposed facial areas(68.8%). 97.3% of lesions occurred in single site. The average course was 22.7±6.9 months. Ulcer lesion was the most frequently seen type(28.2%). 89.8% patients could be confirmed at the first diagnosis. Dermatoscopy was of great value for diagnosis, but the misdiagnosis rate(including missed diagnosis rate) remained as high as 21.1%. 91% of lesions were treated by surgical resection and 86.4% were further cured with adjacent flaps. The one-time cure rate of surgical resection was 93.8%. Intraoperative multipoint freezing combined with Mohs micrography surgery helped to judge whether the leision was completely resected. Conclusion: Facial BCC is easy to be ignored for its relatively concealed condition and slow progress at an early stage. Dermatoscopy can improve the correct diagnosis rate of facial BCC, histopathological examination is still the gold standard though. Empirically determining the margin of surgical resection before surgery can guarantee the accuracy rate to certain extent, however, intraoperative multipoint freezing combined with Mohs micrography surgury is recmmended to improve the accuracy of surgery if conditions permit.