Study to determine whether intraoperative frozen section biopsy improves surgical treatment of non-melanoma skin cancer

Abstract

Abstract. Skin cancers are the most common types of cancer and their incidence has shown an increase of ~4 to 8% per year over the last 40 years. The majority of skin cancers (~97%) are non-melanoma skin cancers, mainly represented by basal cell (80%) and squamous cell carcinomas (20%). The use of intra-operative frozen section remains controversial in the surgical treatment of non-melanoma skin cancer, being commonly considered an optional tool, the reliability and effectiveness of which remain questionable. A large retrospective study was conducted to examine 670 surgical excisions of non-melanoma skin cancers of the head and neck in 481 patients over a period of nine years, between May, 2002 and December, 2011, at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy. Results demonstrated the paradoxical ineffectiveness of an intra-operative frozen section biopsy in pursuing higher rates of radical excision in non-melanoma skin cancers. Nevertheless, a more detailed analysis on the use of frozen sections focusing on the various anatomical sites of the body demonstrated a reverse trend in the eyelids and canthi, where a higher success rate (87.50 vs. 69.77%) in the surgical treatment of non-melanoma skin cancers was obtained with the use of an intra-operative frozen section biopsy. Results of the present study suggested that intra-operative frozen section biopsy be routinely used in the surgical treatment of nonmelanoma skin tumors involving the eyelids and canthi.

The importance of margins in head and neck cancer

“…The routine use of frozen section analysis for cSCC for has been well established [88][89][90][91]. Overall accuracy is estimated to between 90-98%, which is comparable to accuracy rates for MMS [88][89][90][91]. In previous reports, 11-16% of all surgical excisions for cSCC show incomplete excision margins [92][93][94].…”

“…The routine use of frozen section analysis for cSCC for has been well established . Overall accuracy is estimated to between 90–98%, which is comparable to accuracy rates for MMS .…”

Quelles marges d’exérèse pour les carcinomes de paupières ?

“…Nicoletti et al ont montré que l'exérèse était complète pour 62 % de leur série de carcinomes du canthus médial sans examen extemporané. Par contre cette exérèse complète était de 89 % lorsque l'analyse était extemporanée [7]. Cependant l'examen extemporané peut être difficile car le tissu cutané du canthus médial est fin et friable.…”

“…Pour diminuer les marges d'exérèse, il existe deux solutions : l'examen extemporané, et la chirurgie en deux temps [4][5][6]. En étudiant, à partir d'une série de 481 patients atteints de carcinomes de la tête et du cou, seule l'analyse extemporanée pour les lésions des paupières (bord libre et canthus) avait un intérêt [7]. Nous différen-cierons dans cet article, les lésions du bord libre des lésions du canthus médial, et nous différencierons la chirurgie en un temps de la chirurgie en deux temps (reconstruction différée).…”

A Diagnostic Accuracy Comparison Between Tzanck Smear Test and Frozen Section Examination in Basal Cell Carcinoma

“…Nonmelanoma skin cancer is the most common type of cancer (2) that is mainly represented by basal cell carcinoma (BCC) (80%) and squamous cell carcinomas (SCC) (20%) (3). The BCC is the most common malignancy worldwide in white people (4).…”