A NATIONWIDE study of basal cell carcinoma (BCC) excisions in Denmark found that hospital-based specialists have significantly lower odds of incomplete removal than their practice-based peers, raising important questions about treatment setting and provider expertise. The findings come as the burden of BCC, especially on the head and neck, continues to grow, challenging healthcare systems to deliver efficient, high-quality care.
Researchers reviewed 7,774 histopathologically confirmed BCC excisions performed in 2022 using data from the national Patobank. Procedures included standard excisions of head and neck lesions performed without intraoperative margin control. Providers included plastic surgeons, dermatologists, ophthalmologists, and general practitioners (GPs) operating in both hospital and private practice settings.
Plastic surgeons accounted for the largest share of excisions, 43% in hospitals and 38% in practice followed by dermatologists in private practice at 14%. The study identified significant variation not only in the number of procedures performed but also in the likelihood of incomplete excision across settings. Specialists based in hospitals consistently achieved lower rates of incomplete removal than those operating in practice settings. GPs had the highest odds of incomplete excision.
While the intended purpose of excision was not recorded, the consistency of lower incomplete excision rates among hospital-based specialists suggests that provider training and clinical setting play a critical role in treatment quality. The data underscore the need to optimize referral pathways and consider whether certain lesions should be preferentially managed in hospital settings, particularly given the cosmetic and functional sensitivity of head and neck anatomy.
This research supports a more strategic allocation of resources and referrals, aligning case complexity with provider expertise and surgical setting. In a time of rising BCC incidence, ensuring the right patient is treated by the right specialist in the right environment may improve outcomes while preserving healthcare capacity.
Reference:
Kjeldsen EW et al. Head and neck basal cell carcinoma excisions across specialities in hospital and practice settings. Dan Med J. 2025;72(7):A01250029.
