High Magnification Assessment Improves Complete Resection of Facial Tumors

Abstract

Complete resection with minimal sacrifice of healthy skin is the goal in treatment of basal cell carcinoma (BCC) of the face. In a randomized trial, preoperative assessment of tumor extension with the Varioscope, a combination of microscope and loupe glasses with strong illumination and a maximal magnification of 7X, was compared with tumor assessment without. Forty consecutive, primary BCC of the solid subtype of the face were randomly assigned to the study groups. Preoperative tumor marking was done by a surgeon not involved in tumor resection, reconstruction, and patient follow-up. All BCC marked with the high magnification were completely excised in the first resection. In the control group, frozen section was used in 12 tumors and permanent section in the remaining 8. The first resection did not yield tumor-free margins as assessed in the frozen section analysis in 3 tumors. In 2 of 8 tumors not supported by frozen section analysis, incomplete excision was detected, and 1 case of false-negative frozen section analysis occurred. In conclusion, the use of high magnification resulted in a trend towards reduction of positive tumor margins in the subgroups that were performed under either intraoperative frozen section or permanent, fixed section histology control, and a significant reduction in tumor-positive margins of all first resections. This was attributed to enhanced preoperative tumor visualization by high (7X) loupe magnification and additional lighting.

Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma?

“…1Y3 Of all BCCs, 80% to 85% involve the cervicofacial area, related to sun exposure. 9,10 Besides determining the optimal surgical excision margin, various attempts have been made to decrease the rate of incomplete excisions, including the use of loupe magnification (either Â2.3, Â2.5, Â3.5, or Â7) to determine the clinical border of a BCC more accurately. 1,3,6,7 Given the cosmetic importance of the facial region, one aims not only to eradicate a BCC and to prevent recurrence but also to achieve a favorable aesthetic outcome.…”

The bilobed flap in skin cancer of the face: Our experience on 285 cases

“…Importantly, meticulous evaluation and demarcation of the clinical margins using magnification has been shown to reduce the rate of positive surgical margins (Wettstein et al, 2006).…”

Reducing the learning curve for the treatment of morphoeic (sclerosing) basal cell carcinoma of the face

“…The good results obtained in the study of Wettstein et al [10] using the magnification technique encouraged us to use this procedure to reduce the rate of incomplete excisions by our residents.…”

“…To achieve a low rate of incomplete resections, we used enhanced preoperative visualisation of the tumour by high (7)) loupe magnification and additional lighting for the resection of facial mBCC and this resulted in a trend towards fewer invaded tumour margins [10].…”