Predictors of No Residual Disease Following Wide Local Excision of Shave Biopsy-Proven Head and Neck Basal Cell Carcinoma

Objective: To evaluate the prevalence and predictors of no residual disease on wide local excision (WLE) specimens in patients with shave biopsy-confirmed head and neck basal cell carcinoma (BCC). Study Design: Retrospective cohort study of patients in an integrated healthcare system referred from dermatology to otolaryngology—head and neck surgery. Setting: Otolaryngology—head and neck surgery clinic. Methods: We reviewed medical records of adults with shave biopsy-confirmed BCC referred for WLE between January 2022 and December 2023. Data included patient demographics, comorbidities, histologic subtype, and timing of excision. Bivariate and multivariate analyses assessed associations with residual disease status on final pathology. Results: Among 243 cases, 66 (27.2%) WLE specimens had no residual tumor found on pathologic analysis. Patients with no residual disease were younger on average compared to those with residual cancer (65.4 ± 14.2 years vs 72.6 ± 13.0 years, P < .001). Of the 97 female patients, 39 (40.2%) had no residual disease and female sex was independently associated with no residual disease (odds ratio 3.398, 95% confidence interval 1.80-6.42, P < .001). Histologic subtype, diabetes, transplant history, and prior radiation showed no significant associations. Conclusion: Over one-quarter of patients had no residual tumor at excision, particularly younger individuals and women. These findings underscore the value of individualized risk assessment during preoperative counseling, especially for elderly or frail patients and those with lesions in cosmetically sensitive regions. Predictive models incorporating patient-level factors may help reduce overtreatment and improve decision-making in BCC management.