BACKGROUND: Histology reports of skin tumour excisions frequently describe a histological margin significantly less than the planned surgical excision margin. OBJECTIVES: A novel method of marking visible tumour margin was devised. This allowed us to evaluate the accuracy of tumour detection and to compare tissue contraction of the clinically normal perilesional skin with that of tumour tissue following excision and fixation. METHODS: Forty-four well-defined basal cell carcinomas were excised from 42 patients. The visible tumour edge was marked by scoring with a blade around its circumference prior to excision. This allowed comparison of visible and true histological tumour margin. The excision margin was carefully measured from the scored line and the tumour excised. After tissue fixation and processing the histological dimensions of tumour and perilesional margin skin were compared with the pre-excision measurements. RESULTS: The tumour edge was accurately identified to within 1 mm in 67% of margins and was underestimated in only 4%. The whole specimen contracted by a mean of 14%. Skin containing tumour contracted by a mean of 11% but adjacent tumour-free skin in the same plane contracted by a mean of 19%. There was no significant effect of age and site on difference in percentage shrinkage between tumour and margin. CONCLUSIONS: We underestimated tumour extent at only 4% of margins. Tissue shrinkage was the most important factor affecting eventual histological margin. Our novel technique allowed us to demonstrate that this shrinkage is not uniform across the specimen, but is disproportionately high in the tumour-free margin. This suggests that previous estimates of margin shrinkage, based on whole-specimen contraction measurements, may have been erroneously low.
BACKGROUND: Histology reports of skin tumour excisions frequently describe a histological margin significantly less than the planned surgical excision margin. OBJECTIVES: A novel method of marking visible tumour margin was devised. This allowed us to evaluate the accuracy of tumour detection and to compare tissue contraction of the clinically normal perilesional skin with that of tumour tissue following excision and fixation. METHODS: Forty-four well-defined basal cell carcinomas were excised from 42 patients. The visible tumour edge was marked by scoring with a blade around its circumference prior to excision. This allowed comparison of visible and true histological tumour margin. The excision margin was carefully measured from the scored line and the tumour excised. After tissue fixation and processing the histological dimensions of tumour and perilesional margin skin were compared with the pre-excision measurements. RESULTS: The tumour edge was accurately identified to within 1 mm in 67% of margins and was underestimated in only 4%. The whole specimen contracted by a mean of 14%. Skin containing tumour contracted by a mean of 11% but adjacent tumour-free skin in the same plane contracted by a mean of 19%. There was no significant effect of age and site on difference in percentage shrinkage between tumour and margin. CONCLUSIONS: We underestimated tumour extent at only 4% of margins. Tissue shrinkage was the most important factor affecting eventual histological margin. Our novel technique allowed us to demonstrate that this shrinkage is not uniform across the specimen, but is disproportionately high in the tumour-free margin. This suggests that previous estimates of margin shrinkage, based on whole-specimen contraction measurements, may have been erroneously low.
Authors: Oriol Yélamos; Miguel Cordova; Nina Blank; Kivanc Kose; Stephen W Dusza; Erica Lee; Milind Rajadhyaksha; Kishwer S Nehal; Anthony M Rossi Journal: JAMA Dermatol Date: 2017-12-01 Impact factor: 10.282
Authors: Yiqiao Liu; Ethan Walker; Sukanya Raj Iyer; Mark Biro; InYoung Kim; Bo Zhou; Brian Straight; Matthew Bogyo; James P Basilion; Daniel L Popkin; David L Wilson Journal: J Med Imaging (Bellingham) Date: 2019-03-18
Authors: Kush Lalwani; Anand Giddabasappa; Danan Li; Peter Olson; Brett Simmons; Farbod Shojaei; Todd Van Arsdale; James Christensen; Amy Jackson-Fisher; Anthony Wong; Patrick B Lappin; Jeetendra Eswaraka Journal: Comp Med Date: 2013 Impact factor: 0.982
Authors: Nicolas Kuehnert; Nils A Kraemer; Jens Otto; Hank C W Donker; Ioana Slabu; Martin Baumann; Christiane K Kuhl; Uwe Klinge Journal: Surg Endosc Date: 2011-12-17 Impact factor: 4.584
Authors: Thu Tran; Chandru P Sundaram; Clinton D Bahler; John N Eble; David J Grignon; M Francesca Monn; Novae B Simper; Liang Cheng Journal: J Cancer Date: 2015-07-02 Impact factor: 4.207