The significance of "positive" margins in surgically resected epidermoid carcinomas

Sixty-two patients with epidermoid carcinomas of the head and neck (excluding glottic larynx and skin), in whom surgical-resection margins were classified as "positive", were studied to determine the incidence of local recurrence, the subsequent clinical course, and survival. The recurrence rate in this group was compared with that of patients who had "negative" margins. Four histologic findings are classified as positive margins: (1) margin closeness (tumor within 0.5 cm), (2) premalignant change in the margin, (3) in-situ cancer in the margin, and (4) invasive microscopic cancer at the margin. Patients with these variants showed a significant increase in local recurrence and in mortality when compared to those with negative margins. A review of the literature is presented, and recommendations are made for this clinical setting.