Preoperative margin detection by digital dermoscopy in the traditional surgical excision of cutaneous squamous cell carcinomas.
ABSTRACT Abstract Background: The incomplete excision rate is a useful clinical and performance indicator, as it correlates with the treatment, the recurrence rate, the patient's morbidity and mortality. Methods of preoperative assessment of tumoral margins are therefore of paramount importance. Dermoscopy is a simple, non-invasive method, and can also be used for the diagnosis of epithelial tumors. Objective: The aim of the study is to assess the preoperative evaluation of margins with digital dermoscopy, and compare it with clinical evaluation; to ameliorate the surgical performance. Patients and methods: Ninety-four patients with histologically confirmed squamous cell carcinomas were initially selected for traditional surgical excision. Subsequently, the margin of excision was determined by both clinical (group A, 46 patients) and dermoscopy evaluation (group B, 48 patients). Results: In group A, margin involvement was observed in eight (17%) patients. Positive margins were seen in three (6%) patients of group B. Conclusions: Preoperative digital dermoscopy is a better method for detecting tumoral margins than clinical evaluation, and is an effective, simple, non-invasive method for the presurgical evaluation of margins.
- SourceAvailable from: ashfordstpeters.nhs.uk[Show abstract] [Hide abstract]
ABSTRACT: These guidelines for management of primary cutaneous squamous cell carcinoma present evidence based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation. To reflect the collaborative process for the UK, this article is subject to dual publication in the British Journal of Dermatology and the British Journal of Plastic Surgery.British Journal of Plastic Surgery 04/2003; 56(2):85-91. · 1.29 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Scientific evidence for advisable excision margins for nonmelanotic skin carcinoma is poorly documented. Recommended excision margins vary from 2 to 15 mm. A prospective study was performed on 150 skin lesions excised over a 9-month period in an outpatient facility at the authors' institution. Primary nonmelanotic skin lesions were clinically diagnosed as either basal cell carcinoma (nodular, superficial, infiltrating, or sclerosing) or squamous cell carcinoma (well, moderately, or poorly differentiated). Macroscopic surgical excision margins were individually assessed, measured, and excised. Histopathologic analysis was then independently performed to determine the correct diagnosis and to measure the actual microscopic lateral and deep excision margins.Sixty-one percent of lesions were basal cell carcinoma, 25 percent were squamous cell carcinoma, and 15 percent were benign or premalignant. Diagnostic accuracy was 81 percent for basal cell and 59 percent for squamous cell carcinoma. The average diameter of the basal cell carcinoma was 12.1 mm; 47 percent of these lesions had a diameter of less than 10 mm. The average diameter of the squamous cell carcinoma was 16.9 mm; 26 percent of these lesions had a diameter of less than 10 mm. The mean surgical margin was 4.2 mm (3.2 mm adjusted for shrinkage), whereas the mean microscopic lateral margin was 3.4 mm. Overall, complete excision was achieved for 98 percent of basal cell carcinoma and 100 percent of squamous cell carcinoma. The raw data were analyzed to assess the suitability of 1-, 2-, 3-, or 4-mm surgical excision margins. A 4-mm surgical margin would give a microscopic lateral margin beyond one microscopic high-power field (0.5 mm) in 96 percent of cases of basal cell carcinoma and in 97 percent of cases of squamous cell carcinoma. The authors recommend a 4-mm surgical margin as the optimal treatment for skin lesions clinically diagnosed as basal cell or squamous cell carcinoma that are suitable for excision in an outpatient facility. Well-demarcated lesions, such as a nodular basal cell carcinoma, may be excised with a 3-mm margin.Plastic & Reconstructive Surgery 08/2003; 112(1):57-63. · 3.54 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Nonmelanoma skin cancer refers to a broad class of tumors, including actinic keratosis, basal cell carcinoma, and squamous cell carcinoma, and as a group these are the most frequent cancers occurring in light skinned humans. In contrast to the rarity of amelanotic melanoma, nonmelanoma skin cancer commonly lacks pigmentation. Although these tumors rarely cause death related to metastases, they commonly destroy underlying tissues and should be removed at the earliest possible stage. Dermoscopy improves the clinical diagnosis of nonpigmented skin tumors by allowing the visualization of specific vascular structures that are usually not visible to the naked eye. Dermoscopic vascular patterns of several nonmelanocytic nonpigmented skin tumors, such as sebaceous hyperplasia, seborrheic keratosis, clear cell acanthoma, Bowen disease, or nodular cystic basal cell carcinoma are highly specific, allowing a ready diagnosis in most cases. Others, such as actinic keratosis, pyogenic granuloma, or uncommon adnexal tumors, may be difficult to differentiate even with the aid of dermoscopy. For this reason, general guidelines have been established to assist in making the most appropriate management decision. In the second part of this review of dermoscopic vascular structures of nonpigmented skin tumors, the dermoscopic patterns associated with benign and malignant nonmelanocytic skin tumors and recommendations for the management of these tumors will be discussed.Journal of the American Academy of Dermatology 09/2010; 63(3):377-86; quiz 387-8. · 4.91 Impact Factor