INTRODUCTION: Basal cell carcinoma (BCC) is the most common type of skin cancer globally, with its prevalence increasing due to chronic ultraviolet (UV) radiation exposure. Although surgical excision remains the cornerstone of treatment, achieving optimal outcomes requires a careful balance between complete tumor removal and the preservation of cosmetic appearance. OBJECTIVE: This study aims to investigate the relationship between excision margins, reoperation rates, and BCC recurrence through a retrospective analysis of 3036 surgical excisions. METHODS: Conducted at the Department of Plastic Surgery in Trieste, Italy, this study includes data from 2037 patients treated between 2014 and 2018. Excision procedures adhered to standardized hospital protocols. Tumor characteristics, excision margins, and involved anatomical sites were analyzed. RESULTS: The study demonstrated an equal gender distribution (51.02% women), with the nodular subtype (45.85%) being the most common. The head was the most frequently affected site (54.74%). A complete excision rate of 93.3% was achieved, but incomplete excisions were more common in head and neck locations and certain histological subtypes. Surgical reinterventions were primarily performed for high-risk BCCs, significantly reducing recurrence rates (0.52%). CONCLUSION: Reoperation, especially for high-risk BCCs, should be prioritized over conservative management to minimize recurrence. Narrow excision margins were associated with higher recurrence rates, highlighting the importance of adequate margin clearance. This study enhances understanding of the complex interplay between excision techniques, reoperation, and long-term outcomes in BCC management.