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Published on: June 7, 2019
Using frozen section margin control technique to manage non-melanomatous skin lesions in high-risk sites
Metin Nizamoglu1, Helen Douglas1, Ciarstan McArdle1
1Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK; Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK.
Background:
In the UK, non-melanoma skin cancers (NMSCs) that are incompletely excised, recurrent or in sites high risk for incomplete excision are often offered Mohs micrographic surgery (MMS). Variations in waiting times and geographical access to MMS affect patient preference for other treatments. Our unit offers excision of such lesions under complete margin frozen section histological examination.
Methods:
All NMSCs excised at our unit by complete margin frozen section histological analysis from 2010 to 2014 were retrospectively reviewed. The number of excisions required, complete excision rates and recurrences to date were analysed.
Results:
Sixty-nine patients were treated using this technique with a total of 70 lesions excised. Approximately 71% of the excision margins were clear after primary excision, 27% at second excision and 1% at third excision. Patients had a mean follow-up of 12 months (range: 1-48) with no patients lost to follow-up and no recurrences reported to date. Ninety-eight percent of NMSC cases were completely excised and two cases were incompletely excised.
Conclusion:
We have found the rates of excision and recurrence of the high-risk NMSCs excised at our unit to be comparable to those reported with MMS. In addition, our data show that around 29% of patients would have had incomplete margins on primary resection, thus justifying the use of this technique in this group. We suggest that this technique is a safe and useful alternative to MMS in areas where waiting times or geographical patient preference may prohibit its use.
Insights
This study found that complete margin frozen section examination is a safe and effective alternative to Mohs micrographic surgery for non-melanoma skin cancers, achieving comparable excision and recurrence rates.
Area of Science:
- Dermatology
- Surgical Pathology
- Oncology
Background:
- Non-melanoma skin cancers (NMSCs) requiring precise excision often undergo Mohs micrographic surgery (MMS).
- Patient access and waiting times for MMS can influence treatment choices.
- An alternative technique using complete margin frozen section histological examination is employed at our unit.
Purpose of the Study:
- To evaluate the efficacy of complete margin frozen section examination for high-risk NMSCs.
- To compare excision and recurrence rates with established methods like MMS.
Main Methods:
- Retrospective review of NMSCs treated with complete margin frozen section analysis (2010-2014).
- Analysis of excision requirements, complete excision rates, and recurrence data.
- Patient follow-up to assess long-term outcomes.
Main Results:
- Ninety-eight percent of NMSCs were completely excised.
- Approximately 29% of lesions required more than one excision.
- No recurrences were reported during a mean follow-up of 12 months.
Conclusions:
- Complete margin frozen section examination demonstrates comparable excision and recurrence rates to MMS for high-risk NMSCs.
- This technique is a viable and safe alternative to MMS, particularly where access or waiting times are limiting.
- The findings support the utility of this method for ensuring complete tumor removal.
