Objective The aim of the study was to analyze the impact of two-step surgery (primary resection and planned secondary wound closure after final histology results) compared to one-step surgery (resection and immediate wound closure) for non-melanoma skin cancer (NMSC). Methods A total of 225 patients with NMSC median age, 77 years; 68% male; 126 basal cell carcinoma (BCC); 99 cutaneous squamous cell carcinoma (cSCC) treated between 2010 and 2020 were included. Univariate and multivariate analyses were performed with a main focus on the impact of one-step versus two-step surgery. Results One-step versus two-step surgery was performed in 53.8% and 46.2% of the patients. The rate of patients with R+ status after primary resection was lower in the group of patients with planned one-step surgery (23.2%) than in the group of patients with planned two-step surgery (42.3%; p 0.001). The overall final R+ rate was 4.9%. All these patients belonged to the one-step surgery group. The median follow-up time was 17.5 months. A total of 33 patients (14.7%) had a local tumor recurrence during follow-up. The mean time to recurrence after one-step surgery was 105.0 months (CI = 89.7–120.4). After two-step surgery, it was 126.7 months (CI = 118.0–135.5; p 0.001). Multivariate Cox regression revealed the following independent risk factors for lower recurrence-free survival: cSCC [hazard ratio (HR) = 6.838; CI = 1.446–32.330; p = 0.015), further head and neck skin cancers after index tumor (HR = 6.262; CI = 1.705–23.001; p = 0.006), and one-step surgery instead of two-step surgery (HR = 6.519; CI = 1.245–8.020; p = 0.048). Re-surgery as a major complication due to bleeding or wound infections (Clavien–Dindo classification grade III) was necessary in 6.2% of the cases. The re-surgery rate was not different between a one-step surgery and a two-step surgery (p = 0.294). Conclusions Two-step surgery instead of one-step surgery for unselected cases of both BCC and cSCC was associated with a higher rate of complete tumor resections and a lower recurrence rate.
Schneider et al. (Mon,) studied this question.