Variations and Challenges of Cutaneous Oncological Surgery in Morocco

Abstract

Background Oncological skin surgery is a cornerstone in the management of malignant skin tumors; however, no national or international guidelines exist regarding surgical techniques. Objectives This study aimed to assess variation in oncological skin surgery practices and to explore the influence of clinicians' specialty and professional grade on this variation. Methods This national, anonymized, cross-sectional study used an online questionnaire distributed to dermatologists, plastic and reconstructive surgeons, and other specialists performing oncological skin surgery. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Categorical variables were summarized as frequencies and percentages. A p-value < 0.05 was considered statistically significant. Results Among the participants, 81.9% were dermatologists and 11.4% were plastic surgeons. The remaining 6.7% were distributed across other specialties, including maxillofacial surgery (2.6%), general surgery (2.0%), and breast surgery (2.1%); 61.4% were consultants. Most clinicians reported learning surgical techniques informally from senior colleagues (92.1%). Significant variation was observed in wide local excision (WLE) planning and execution. For a 1 cm WLE, 65.9% marked margins from the scar edge, whereas plastic surgeons more frequently measured from the scar center than dermatologists (p = 0.003). Most excisions followed a longitudinal or oblique limb axis (61.4%), and only 40% of clinicians sent dog ears for histological examination. Excision depth varied, most commonly extending to the deep fascia (53.5%). Skin cancers were excised without prior biopsy in 71.3% of cases, with one-stage repair performed in 92.2%, most often by direct closure (83.4%). Complete excision was achieved in 95.2% of cases, with excellent clinicopathological correlation in 89.5%. The overall complication rate was low (3%) but was significantly higher in patients receiving antithrombotic therapy (p < 0.05). Conclusion Substantial variation exists in oncological skin surgery practices. The development of standardized consensus guidelines may improve procedural consistency and potentially enhance patient outcomes.