Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Abstract

ObjectiveTo evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin).MethodsPatients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any.ResultsA total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases.ConclusionTumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease.

The role of adjuvant treatment in early‐stage oral cavity squamous cell carcinoma: An international collaborative study

“…It has been suggested that adequate resection of OCSCC requires at least 5‐mm margins, although smaller margins have also been suggested . Because of the complexity of these tumors, clear margins are achieved in only 50% to 80% of patients treated at cancer centers . Hence, many patients with early OCSCC undergo inadequate surgery.…”

“…6,7 Because of the complexity of these tumors, clear margins are achieved in only 50% to 80% of patients treated at cancer centers. [8][9][10][11][12] Hence, many patients with early OCSCC undergo inadequate surgery.…”

Nomogram for predicting cancer-specific survival of patients with buccal squamous cell carcinoma: a population-based study

“…Our nomogram indicates that pathological grade is the most important factor, while age is the second most important one [15,16], and there is no signi cant difference between grades I and II. Multivariate analyses indicated that older age was an independent risk variable, with older patients having a lower survival rate [9,17,18]. Meanwhile, a higher AJCC stage was associated with worse survival [9].…”

“…Among the three main treatments applied in BSCC, surgery was found to be the only signi cantly effective treatment, and so the radiotherapy and chemotherapy statuses were not included in the nal nomogram. Surgical treatment should be the rst choice of treatment for BSCC [18,20,21], while avoiding unnecessary radiotherapy and chemotherapy can reduce the burden on medical resources, alleviate the additional injury and pain experienced by patients, and reduce costs. This information can further help clinicians to make rational clinical decisions.…”

Management Strategies for Oral Cancer Subsites

“…The surgical plan should involve wide excision of the tumor in all three dimensions with adequate margins ( Table 2). This should account for histopathological shrinkage (approximately 25%) [2]. Due attention must be given specially to the third dimension which is the soft tissue/depth and generally the site of surgical failures.…”