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Background <p>Surgical excision of skin cancer requires balancing oncological safety with patients’ aesthetic expectations. Female patients are often perceived to prioritize cosmetic outcomes more strongly, particularly for facial tumors. This perception may influence surgeons to adopt narrower excision margins, potentially increasing the risk of tumor-positive margins and necessitating revision surgeries.</p> Methods <p>We retrospectively analyzed all patients who underwent primary excision of basal cell carcinoma (BCC) at our department between 2014 and 2023. Histopathological reports were assessed for margin status. We evaluated the impact of gender and age on the frequency of revision surgery and investigated the role of tumor localization and BCC subtype on the rate of incomplete excisions, including gender-specific differences.</p> Results <p>A total of 762 patients (mean age 70.7 years, range 21–96) were included. Tumor remnants were identified in 32.2% of cases. Female patients showed a significantly higher rate of positive margins (38.9%) compared to males (23.4%, <i>p</i> &lt; 0.001), consistent across all anatomical regions (<i>p</i> = 0.001). Tumor location significantly affected margin status (<i>p</i> &lt; 0.001), with incomplete excisions more frequent in the nasal region. Men more frequently had nodular BCC, while women more often presented with superficial subtypes. Notably, females showed higher positive margin rates in nodular and morpheaform subtypes, with nodular tumors requiring revision in 46% of cases. Age and surgeon sex had no significant influence on margin status.</p> Conclusions <p>Our findings highlight the need for a balanced approach to BCC excision that ensures oncological safety across genders. The increased rate of positive margins in female patients suggests potential unconscious gender bias, warranting greater awareness and personalized surgical planning. Level III, risk / prognostic study.</p>

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Balancing aesthetics and oncological safety: uncovering gender bias in skin cancer surgery

  • 期刊论文

  • 发表日期：

    2025年9月3日

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  • Albert Fuchs,
  • Nadalina Johanna Sifkovits,
  • Rupert Koller,
  • Lara Steinkellner,
  • Katharina Egger

摘要

Background

Surgical excision of skin cancer requires balancing oncological safety with patients’ aesthetic expectations. Female patients are often perceived to prioritize cosmetic outcomes more strongly, particularly for facial tumors. This perception may influence surgeons to adopt narrower excision margins, potentially increasing the risk of tumor-positive margins and necessitating revision surgeries.

Methods

We retrospectively analyzed all patients who underwent primary excision of basal cell carcinoma (BCC) at our department between 2014 and 2023. Histopathological reports were assessed for margin status. We evaluated the impact of gender and age on the frequency of revision surgery and investigated the role of tumor localization and BCC subtype on the rate of incomplete excisions, including gender-specific differences.

Results

A total of 762 patients (mean age 70.7 years, range 21–96) were included. Tumor remnants were identified in 32.2% of cases. Female patients showed a significantly higher rate of positive margins (38.9%) compared to males (23.4%, p < 0.001), consistent across all anatomical regions (p = 0.001). Tumor location significantly affected margin status (p < 0.001), with incomplete excisions more frequent in the nasal region. Men more frequently had nodular BCC, while women more often presented with superficial subtypes. Notably, females showed higher positive margin rates in nodular and morpheaform subtypes, with nodular tumors requiring revision in 46% of cases. Age and surgeon sex had no significant influence on margin status.

Conclusions

Our findings highlight the need for a balanced approach to BCC excision that ensures oncological safety across genders. The increased rate of positive margins in female patients suggests potential unconscious gender bias, warranting greater awareness and personalized surgical planning. Level III, risk / prognostic study.