Head And Neck Skin Lesions Pose Surgical Challenges
HEAD and neck skin lesions remain a common and clinically important focus in dermatology surgery, particularly because this region carries high cumulative ultraviolet exposure and includes cosmetically and anatomically complex sites. Non-melanoma skin cancers, including basal cell carcinoma and squamous cell carcinoma, account for a substantial proportion of lesions excised in this area.
A one-year audit from a large dermatology department in South Wales, UK, reviewed surgical outcomes for head and neck skin lesion excisions performed between 2022 and 2023. The audit assessed compliance with British Association of Dermatologists guidance across different clinician groups, using data from a dermatology surgery booking list, histology reports, and clinic letters.
Excision Outcomes Show Diagnosis-Specific Variation
The audit included 965 total excisions, of which 250 were benign and 715 had malignant histology. Among malignant lesions, 633 were completely excised and 82 were incompletely excised, giving an overall complete excision rate of 89%.
Basal cell carcinoma was the most frequent diagnosis, accounting for 449 cases, or 62.9% of malignant excisions. Complete excision was achieved in 421 basal cell carcinoma cases, corresponding to a 94% complete excision rate. This was close to the expected excision rate of 95% noted in the poster conclusion.
Squamous cell carcinoma accounted for 234 cases, or 32.7% of malignant excisions, with 194 complete excisions and 40 incomplete excisions. This produced a complete excision rate of 83%. Melanoma outcomes were more variable, with 23 cases recorded, 12 complete excisions, and 11 incomplete excisions, although interpretation is limited by the smaller sample size and the likely need for planned wider management in some cases.
Follow-Up Documentation Remains A Key Audit Point
Among the 82 incomplete excisions, 52 proceeded to repeat excision, wide local excision, or Mohs surgery. However, 22 cases had no follow-up or further documentation recorded, highlighting an important service-level opportunity for improved tracking after incomplete excision.
The audit did not include formal statistical analysis, but the findings provide a useful departmental snapshot of surgical activity, diagnostic distribution, and variation in excision completeness across head and neck skin lesions. The conclusion emphasized that further study and analysis could support ongoing improvement in dermatology services, particularly in standardizing follow-up pathways and ensuring timely intervention when margins are incomplete.
Reference
Elmusry AM et al. Surgical Outcomes of Head and Neck Skin Lesions: A One-Year Audit of Dermatology Practice in South Wales. SCALE Music City, May 13-17, 2026.
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