When does skin excision allow the achievement of an adequate local control rate in patients with squamous cell carcinoma involving the buccal mucosa?

Background: The role of cheek skin excision in patients with squamous cell carcinoma of the buccal mucosa (BSCC) remains controversial. We sought to investigate when skin excision is needed to achieve an adequate local control. Methods: A total of 331 patients with BSCC were reviewed. Skin preservation was pursued when the distance between the tumor and the skin as determined by imaging was ≥13 mm (1 cm surgical margin plus 0.3 cm skin preservation). Two hundred and thirty patients (69.5%) underwent skin excision. Postoperative adjuvant radiotherapy (n = 182) was performed in patients with pathological T4 disease, metastases in cervical lymph nodes or close pathological margins (≤4 mm). The 5-year local control rate was plotted by Kaplan-Meier analysis. Results: Twenty-four patients (7.3%) had close pathological margins. The 5-year local control rate did not differ significantly between patients treated either with or without skin excision. This was verified both in subjects who received surgery alone (94% versus 91%) and in those who received surgery plus adjuvant therapy (82% versus 86%). Conclusion: In patients with BSCC, a good 5-year local control rate may be equally achieved either with or without skin excision. In patients with pT3 disease, postoperative radiotherapy is not recommended in the absence of close pathological margins. Our findings may guide clinical decision-making on skin excision in this patient group.