Excision margin for cutaneous squamous cell carcinoma: is it standardised?

In January 2002, the Multiprofessional Skin Cancer Committee published guidelines on the management of cutaneous squamous cell carcinoma (SCC). We have undertaken a survey amongst plastic surgeons in the UK in order to establish the current standards for excision margins of SCC. There was no consensus on the excision margin to be taken for an SCC, nor was there any agreement as to whether a completely excised SCC ever warranted further excision. Furthermore, the majority of surgeons would take a wider margin for SCC on the limbs, but not for those on the head and neck. This is in contrast to the guidelines, which recommend a larger margin for the high-risk sites of the ear, lip, scalp, eyelids and nose. In addition, most pathology reports comment on completeness of excision margins but only few mention the depth of the tumour. We discuss the evidence behind the current guidelines and look at areas for improvement in the standardisation of the management of SCC.