Chemosurgery

The terms "chemosurgery," "microscopically controlled surgery," and the shortened form "microcontrolled surgery" all serve to designate a method by which cancer of the skin may be excised under complete microscopic control. This microscopic control is accomplished by excising the cancerous area layer by layer and examining the entire undersurface of each layer under the microscope by the systematic use of frozen sections. The layers of tissue may be excised after prior chemical fixation of the tissues with zinc chloride (the fixed tissue technique) or the layers may be excised in the fresh, unfixed state after injection of a local anesthetic (the fresh tissue technique). The fixed tissue technique is indicated for extensive, complicated cancers that invade into or around bony structures, for cancers invading the erectile tissues of the penis, and for melanoma. The fresh tissue technique is indicated for almost all other cutaneous cancers. Dual advantages conferred by the microscopic control are, first, guarantee of eradication of the cancer, including its clinically unpredictable ramifications and, second, the maximal conservation of normal tissues. The operative risk is low because no general anesthetic is used and because patients remain ambulatory. The tissues heal well whether by second intention or by immediate or delayed repair. The microscopic control, as well as the other technical advantages of the method, extends operability to some patients with cancers so extensive and complicated that there would be little likelihood of cure with methods lacking such control. Facilities and trained personnel for the use of microcontrolled surgery eventually should be available in all large population centers.