Excisão cirúrgica circular versus excisão fusiforme no tratamento do câncer da pele não melanoma

Abstract

Skin cancer is the most common malignant tumor in Brazil and in the world. 1,2,3 Although there are a variety of therapeutic modalities available, surgical excision with recommended margins in the literature is considered the gold standard of treatment. 3 Many techniques are described for the excision of such lesions, with elliptical or fusiform excision being the most used in medical practice due to the practicality of its execution. 9 However, studies have shown that this technique appears to sacrifice a large area of healthy skin, since the fusiform excision must be 3 to 4.5 times the size of the area to be excised (tumor size plus the recommended surgical margin) for adequate closure, which can lead to formation of large and unaesthetic surgical scars. 9,10 Therefore, it is suggested in the literature that circular excision is an alternative to fusiform excision, as it seems to preserve a larger area of normal skin, leading to a smaller surgical scar that is better oriented along the skin's tension lines. 9,10 The objective of this study was to compare the fusiform and circular excision techniques in the treatment of non-melanoma skin cancer and determine which of these two techniques presents the best results, evaluating the length and final orientation of the scar, with an emphasis on aesthetic and oncological outcomes. For this, 67 patients were recruited from the dermatology outpatient clinic of Hospital Universitário Pedro Ernesto (HUPE) aged ≥ 18 years and with primary lesions suspected of basal cell or squamous cell carcinoma, with a diameter ≤ 2 cm, located on the trunk or limbs. During surgery, all suspected lesions were submitted to circular marking of the margin established by the medical literature, from which the ellipsis was subsequently drawn, following the length: width ratio of 3:1, parallel to the skin tension lines. All lesions were then excised in a circular manner at their surgical margin with subsequent correction or not of possible “dog ears”, which are excess skin that can form with primary cutaneous closure. Finally, the final surgical scar was compared with the recommended fusiform design in terms of size and orientation. All data were analyzed using Student's T tests and Spearman's non-parametric correlation. Of the 67 surgeries performed, 63 were compatible with basal cell or squamous cell carcinoma and all had free margins. Furthermore, in 100% of cases a surgical scar was formed smaller than the diameter of the programmed ellipsis and in 19 (29.7%) cases there was a change in the final orientation of the scar. Therefore, the results indicate that circular excision forms a smaller and often (in 30% of cases) better oriented scar, when compared to fusiform excision, guaranteeing a better healing result without compromising the oncological treatment.