OBJECTIVE: To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique. STUDY DESIGN: Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature. RESULTS: For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months). CONCLUSION: The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.
OBJECTIVE: To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique. STUDY DESIGN: Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature. RESULTS: For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months). CONCLUSION: The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.
Authors: Nestor R Rigual; Gal Shafirstein; Jennifer Frustino; Mukund Seshadri; Michele Cooper; Gregory Wilding; Maureen A Sullivan; Barbara Henderson Journal: JAMA Otolaryngol Head Neck Surg Date: 2013-07 Impact factor: 6.223