Frozen section analysis in the management of skin cancers

Frozen section analysis is used routinely to ensure complete removal of basal cell and squamous cell carcinomas of the skin, but the current emphasis on controlling costs raises the question as to which lesions should be evaluated with frozen section histology. A retrospective study of the clinical records and pathological reports of 51 patients selected randomly from a total of 225 patients was undertaken to determine the overall impact of frozen section analysis on the surgical management of skin cancers at this institution. The results indicate that frozen section analysis was performed on 76% of the 277 lesions evaluated, and that the results of frozen section examination were 91.1% accurate in detecting the presence or absence of tumor involvement at the surgical margins. The data also showed that the surgeons were able to estimate the margin of the skin tumor clinically and remove it entirely during the first excision 91.1% of the time. The lesions that had not been removed completely with the initial excision were those located on the periorbital region, forehead, and cheeks; were recurrent lesions; or were lesions that required more involved reconstruction than primary closure. This study shows that frozen section analysis is a valuable tool in selected situations, but routine use is not indicated for the majority of basal and squamous cell carcinomas of the skin.