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The double scalpel and double punch excision of skin tumors
Abstract:
A new technic is described for more accurately checking the surgical margins of skin tumors removed by standard surgical excision. Vertical sections of surgical specimens represent check points of the margin only 7 microns thick. This means most of the surgical margin is not checked microscopically, allowing small tumor islands at the margin to remain undetected. The technic is applicable wherever surgical excision is used to excise skin tumors. It is especially suitable for basal cell carcinoma. A variable-width knife holding two scalpel blades parallel to each other is set at 2 to 3 mm separation. When the excision is done as usual, the blades will cut a 2- to 3-mm strip of tissue representing the entire lateral borders of the excision. This specimen is easily mounted as a flat section for frozen or paraffin processing. These sections will be cut to show the entire lateral excision margin to be checked for tumor. A new punch with concentric cutting edges separated by 2 mm has been made to obtain a similar flat section. The circular defect is converted to a standard ellipse and closed primarily. This technic has the advantage of using primary closure for excellent cosmetic results. It requires little additional skill on the part of the surgeon and is easily handled by the pathology laboratory. It has been used in thirteen cases with no recurrence of tumors to date.
Insights
A novel surgical technique improves skin tumor margin assessment by examining a wider tissue strip, reducing recurrence risk. This method enhances detection of residual tumor cells after excision.
Area of Science:
- Dermatology
- Surgical Pathology
- Oncology
Background:
- Standard vertical sections of surgical specimens offer limited microscopic margin assessment (7 microns).
- This limitation can lead to undetected residual tumor islands at the surgical margin.
- Accurate margin assessment is crucial for preventing skin tumor recurrence.
Purpose of the Study:
- To introduce a new technique for more accurate assessment of surgical margins in skin tumor excisions.
- To improve the detection of residual tumor cells at the excision site.
- To enhance cosmetic outcomes through primary closure of defects.
Main Methods:
- Utilizing a variable-width knife with parallel scalpel blades (2-3 mm separation) to excise a wider lateral border strip.
- Employing a novel punch with concentric cutting edges (2 mm separation) for similar flat section acquisition.
- Processing specimens as flat sections for frozen or paraffin embedding and microscopic examination.
Main Results:
- The technique allows for comprehensive microscopic examination of the entire lateral excision margin.
- Primary closure of the resulting defect offers excellent cosmetic results.
- Initial application in thirteen cases showed no tumor recurrence to date.
Conclusions:
- This improved technique enhances the accuracy of surgical margin assessment for skin tumors.
- It is particularly suitable for basal cell carcinoma and other skin malignancies.
- The method is surgeon-friendly, pathology-compatible, and yields superior cosmetic results.