Effective excision of cutaneous squamous cell carcinoma of the face using analysis of intra‐operative frozen sections from the whole specimen

Hutting, Kor H.; Bos, Paul G.; Kibbelaar, Robby E.; Veeger, Nic J. G. M.; Marck, Klaas W.; Mouës, Chantal M.

doi:10.1002/jso.24870

Cited by 7 publications

(13 citation statements)

References 23 publications

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“…Hutting et al and Kedilioglu et al have previously determined the accuracy of the WIFSA technique. Hutting et al and Kedilioglu et al each found a total agreement of 98.8% . In this study, we calculated a total accuracy of 98.4%, which confirms these earlier reports.…”

Section: Discussionsupporting

confidence: 92%

“…As well as accurate, WIFSA has been proven to be a fast technique for analyzing the excision margins . We emphasize this by demonstrating that on average, for radical removal of the tumor, 1.4 excisions were needed.…”

Section: Discussionmentioning

confidence: 86%

“…In the Medical Centre Leeuwarden in the Netherlands, we use the whole specimen intraoperative frozen section analysis (WIFSA), which is a bread‐loafing technique. Previous studies have demonstrated that WIFSA is a fast and accurate frozen section technique with a low recurrence rate at 5 years follow‐up …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated that WIFSA is a fast and accurate frozen section technique with a low recurrence rate at 5 years follow-up. 10,11 BCCs typically develop with a slow growth rate due to alternating periods of progression and regression. 12 Owing to this slow growth rate, recurrences tend to present fairly late after primary treatment.…”

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confidence: 99%

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Long‐term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA

Scholten

Kedilioglu

Huizinga

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Recent studies show that whole specimen intraoperative frozen section analysis (WIFSA) is a reliable method for margin analysis in basal cell carcinoma (BCC) and has low recurrence rates after five‐years follow‐up. There are no studies with longer follow‐up. Our aim is to present long‐term recurrence rates after WIFSA. Materials and Methods All patients with a facial BCC receiving excision with WIFSA between 1992 and 2007 were evaluated. Recurrence rates were examined for primary BCC (pBCC), recurrent BCCs (rBCC), and the different histological subtypes. The accuracy of WIFSA was assessed by comparing with formalin‐fixed paraffin‐embedded section analysis. Results A total of 1140 patients with 1265 BCCs underwent excision with WIFSA, with a median and maximum follow‐up of 10 and 25.3 years, respectively. Of all tumors, 90.0% were primary. Excisions were radical after an average of 1.4 excision rounds;5, 10, and 15‐year recurrence rates for pBCCs are 3.3%, 5.1%, and 7.3%, respectively. An aggressive growth pattern and rBCCs are associated with more recurrences. The accuracy of WIFSA is 98.4%. Conclusions WIFSA provides a highly accurate analysis and has a low recurrence rate for primary BCCs. The increasing recurrence rates over time imply 5 years of follow‐up may be insufficient.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Long‐term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA

Scholten

Kedilioglu

Huizinga

et al. 2019

Journal of Surgical Oncology

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“…Die Breite der histologischen Brotlaibschnitte im Rahmen der WLE wird in der gesamten vorliegenden Literatur nur zweimal angegeben: 1–4 Querschnitte bei medianem Tumordurchmesser von 17 mm von 120 PEK und 1–3 mm breite Streifen bei Tumordurchmesser < 20 mm in 83 % von 160 PEK . Die Definition für R0 oder randbildend R1 ist in den hierzu gefundenen Publikationen nicht einheitlich.…”

Section: Ergebnisseunclassified

Lokale chirurgische Therapie des kutanen Plattenepithelkarzinoms: Defizite und Kontroversen in der Literatur

Breuninger

Eigentler

Häfner

et al. 2019

J Deutsche Derma Gesell

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Zusammenfassung Der Einfluss der Primärexzision eines kutanen Plattenepithelkarzinoms auf die Prognose ist abhängig von den Risikofaktoren des Tumors, den chirurgischen Therapiemodalitäten und der histologischen Untersuchung. Im Zuge der AWMF‐Leitlinie Plattenepithelkarzinom wurden mittels DELBI‐Verfahren die aussagekräftigsten Leitlinien herangezogen. Dies waren die schottische, die kanadische und die gemeinsame Leitlinie der EDF, EADO und EORTC. Die Aufarbeitung der Primärliteratur dieser Leitlinien zu oben genannten Themen ergab 49 Studien und 9 Reviews. Keine Studie bot ein prospektives randomisiertes Schema, 19 enthielten prospektiv erhobene Daten, 30 retrospektive Daten. Insgesamt zeigten die Studien heterogene Ergebnisse. Es gab Diskrepanzen hinsichtlich der Wertigkeit der Risikofaktoren zur lokoregionären Progression, wie Entdifferenzierung, Desmoplasie und perineuraler Invasion, teils auch Tumordicke und chirurgischer Konsequenzen. Auch bei der histologischen Aufarbeitung ergaben sich Unterschiede. Die Literatur unterscheidet prinzipiell zwei Methoden der histologischen Aufarbeitung: die konventionelle Histologie mittels Lamellen (Brotlaib‐Histologie) und die lückenlose Randschnitt‐Histologie. Für Letztere zeigten die Studien niedrige Rezidivraten, aber auch niedrige Metastasierungsraten, eventuell infolge risikoärmerer Kollektive gegenüber ersterer Methode. Bei Publikationen zur Brotlaib‐Histologie fehlten genaue Angaben über die definitive Aufarbeitung. Ebenso fehlten verwertbare Angaben zum primären Resektionsabstand. Fazit: Die aktuelle Literatur ist uneinheitlich und insuffizient bezüglich der einzelnen prognostischen Faktoren und den Maßnahmen der chirurgischen Versorgung des kutanen Plattenepithelkarzinoms.

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Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

et al. 2023

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ImportancePrimary cutaneous squamous cell carcinoma is usually curable; however, a subset of patients develops poor outcomes, including local recurrence, nodal metastasis, distant metastasis, and disease-specific death.ObjectivesTo evaluate all evidence-based reports of patient risk factors and tumor characteristics associated with poor outcomes in primary cutaneous squamous cell carcinoma and to identify treatment modalities that minimize poor outcomes.Data SourcesPubMed, Embase, and SCOPUS databases were searched for studies of the topic in humans, published in the English language, from database inception through February 8, 2022.Study SelectionTwo authors independently screened the identified articles and included those that were original research with a sample size of 10 patients or more and that assessed risk factors and/or treatment modalities associated with poor outcomes among patients with primary cutaneous squamous cell carcinoma.Data Extraction and SynthesisData extraction was performed by a single author, per international guidelines. The search terms, study objectives, and protocol methods were defined before study initiation. A total of 310 studies were included for full-text assessment. Owing to heterogeneity of the included studies, a random-effects model was used. Data analyses were performed from May 25 to September 15, 2022.Main Outcomes and MeasuresFor studies of risk factors, risk ratios and incidence proportions; and for treatment studies, incidence proportions.ResultsIn all, 129 studies and a total of 137 449 patients with primary cutaneous squamous cell carcinoma and 126 553 tumors were included in the meta-analysis. Several patient risk factors and tumor characteristics were associated with local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death were identified. Among all factors reported by more than 1 study, the highest risks for local recurrence and disease-specific death were associated with tumor invasion beyond subcutaneous fat (risk ratio, 9.1 [95% CI, 2.8-29.2] and 10.4 [95% CI, 3.0- 36.3], respectively), and the highest risk of any metastasis was associated with perineural invasion (risk ratio, 5.0; 95% CI, 2.3-11.1). Patients who received Mohs micrographic surgery had the lowest incidence of nearly all poor outcomes; however, in some results, the 95% CIs overlapped with those of other treatment modalities.Conclusions and RelevanceThis meta-analysis identified the prognostic value of several risk factors and the effectiveness of the available treatment modalities. These findings carry important implications for the prognostication, workup, treatment, and follow-up of patients with primary cutaneous squamous cell carcinoma.Trial RegistrationPROSPERO Identifier: CRD42022311250

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Effective excision of cutaneous squamous cell carcinoma of the face using analysis of intra‐operative frozen sections from the whole specimen

Abstract: Surgical excision with WIFSA is an excellent treatment modality for cSCC of the face because of its accurate method for assessment of complete tumor removal, low recurrence and metastasis rate, short average duration of treatment, and low complication rate.

Cited by 7 publications

References 23 publications

Long‐term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA

Long‐term recurrence rates of whole specimen intraoperative frozen section analysis in basal cell carcinomas of the face with WIFSA

Lokale chirurgische Therapie des kutanen Plattenepithelkarzinoms: Defizite und Kontroversen in der Literatur

Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

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