Dermatologic SurgeryAccuracy of serial transverse cross-sections in detecting residual basal cell carcinoma at the surgical margins of an elliptical excision specimen
Section snippets
Methods
A prospective Institutional Review Board–approved study compliant with the principles of the Declaration of Helsinki was conducted in which biopsy-proven, small (<1 cm), well-defined, primary, nonmorpheaform facial basal cell carcinomas were excised as an ellipse. Ellipses were designed as eccentric parallelograms with 2-mm surgical margins of normal-appearing tissue around the visible portion of the tumor.3 The ellipses were bisected longitudinally and flattened laterally to allow complete
Results
A total of 42 tumors that were excised with 2-mm surgical margins and bisected into 2 semiellipses with histologically positive margins on frozen section pathology were identified and included in this study. Of these, 34 had one positive margin and 8 had two positive margins (16 slides). Thus a total of 50 slides (34 + 16) with positive surgical margins were included in the study.
The results of the study are summarized in Table I. The number of slides in which the transverse cross-sectional lines
Discussion
To our knowledge, this is the first study to address the accuracy of the bread-loaf technique in identifying residual basal cell carcinoma at an excisional surgical margin. We selected small (<1 cm), well-demarcated, nonmorpheaform facial tumors, as these tumors are often treated with elliptical excision in clinical practice. Moreover, we used 2-mm surgical margins because 4-mm margins are often not used on the face because of anatomic considerations.
We used 4-mm wide increments to measure
References (8)
- et al.
Mohs micrographic surgery
J Am Acad Dermatol
(1998) Comparison of methods for checking surgical margins
J Am Acad Dermatol
(1990)- et al.
Elliptical excisions: variations and the eccentric parallelogram
Arch Dermatol
(2004) - et al.
Mohs micrographic surgery for elliptical excisions of skin tumors: a surgical and histologic study
Dermatol Surg
(2004)
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2020, Journal of the American Academy of DermatologyCitation Excerpt :A meta-analysis suggested 3-mm margins for nonmorpheaform BCCs less than 2 cm, but data were based on bread loaf (vertical sections) analysis, which limits their validity.17 Bread loaf sections evaluate approximately 1% of the peripheral margins and may miss tumor extension at nonvisualized surgical margins.18,19 An important study demonstrated that narrow margins (1-3 mm) were inadequate for the elliptic excision of primary, well-demarcated nodular BCCs less than 1 cm on the face, given the 20% probability of encountering surgical margins positive for BCCs.20
Negative predictive value of biopsy margins of dysplastic nevi: A single-institution retrospective review
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Funding sources: None.
Conflicts of interest: None identified.