Surgical versus pathological excision margins—an excision too far?

Davis, Marcus; Monk, Barry

doi:10.1007/s00238-009-0384-x

Cited by 4 publications

(9 citation statements)

References 9 publications

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“…Mean length and width shrinkage after excision were 12% and 19%, respectively, similar to shrinkage values reported elsewhere for excised human skin tumors; 16% and 18% 7 ; 17% and 9%. 8 As collagen and elastin fibres are largely orientated parallel to the skin surface, retraction is presumably greater horizontally leading to an overall thickening of the sample vertically. However, ex vivo ultrasound measurements were only 5% thicker than in vivo.…”

Section: Skin Thickness Measurements Increase With Excision and Biopsmentioning

confidence: 99%

Skin thickness measurements increase with excision and biopsy processing procedures

Andrews

Kempf

Kimble

et al. 2017

Wound Repair Regeneration

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Section: Skin Thickness Measurements Increase With Excision and Biopsmentioning

confidence: 99%

Skin thickness measurements increase with excision and biopsy processing procedures

Andrews

Kempf

Kimble

et al. 2017

Wound Repair Regeneration

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“…The dermis has a high content of elastin and excision reduces the normal skin tension, allowing the dermis to recoil. Mean length and width shrinkage after excision was 12% and 19% respectively, similar to shrinkage values reported elsewhere for excised human skin tumours; 16% and 18% (101); 17% and 9% (227). As collagen and elastin fibres are largely orientated parallel to the skin surface, retraction is presumably greater horizontally leading to an overall thickening of the sample vertically.…”

Section: Resultssupporting

confidence: 81%

Validating the relationship between burn temperature, duration of exposure and tissue injury severity for scald burns

Andrews¹

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Scald injury events are a common occurrence in early childhood. To reduce the risk to children of sustaining severe burn injuries, understanding the relationship between water temperatures, duration of exposure and tissue injury severity is essential. Current data used to predict the severity of burn injury and guide global scald burn prevention strategies is from the 1940s and has never been validated histologically for differentiating between superficial and deep dermal damage. While all burn injuries are painful and distressing for a child, severe deep dermal burns will require hospitalisation for extensive medical treatment, surgical intervention and may lead to scarring in the long term. Therefore it is essential to appreciate not only the burn conditions predicted to result in a cutaneous injury, but also to estimate the severity of injury, with particular reference to the more serious and clinically relevant deep dermal and full thickness burns.

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“…The margin in turn helps one to assess future risk and so make decisions as to whether further excision, follow‐up, or discharge is appropriate 1,2 . An over‐estimate of shrinkage may lead one to under‐estimate risk while under‐assessment of shrinkage may lead to over‐excision 1 …”

Section: Introductionmentioning

confidence: 99%

“…1 The margin in turn helps one to assess future risk and so make decisions as to whether further excision, follow-up, or discharge is appropriate. 1,2 An over-estimate of shrinkage may lead one to under-estimate risk while underassessment of shrinkage may lead to over-excision. 1 Medical research requires an accurate measure so studies of in vivo/clinical margins can be compared with studies based on margins of fixed pathology specimens.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 An over-estimate of shrinkage may lead one to under-estimate risk while underassessment of shrinkage may lead to over-excision. 1 Medical research requires an accurate measure so studies of in vivo/clinical margins can be compared with studies based on margins of fixed pathology specimens. 3 Third Party Assessments raise the spectre of both legal implications of appropriate malignant tumour margin resection and downcoding of surgical codes due to discrepancies in surgical and pathology reports.…”

Section: Introductionmentioning

confidence: 99%

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Skin tumour specimen shrinkage with excision and formalin fixation—how much and why: a prospective study and discussion of the literature

Waal

2021

ANZ Journal of Surgery

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Background: Surgical skin specimens are known to undergo significant shrinkage when excised and processed. The degree of shrinkage is important for medical care, research and third-party assessment. Studies to date have shown variable degrees of shrinkage. Most have included multiple and sometimes unspecified variables-different surgeons, varied sites, ill-defined excision patterns and/or multiple pathologies. This study tries to exclude many of these variables to try to ascertain a more accurate predictor of shrinkage with a single surgeon, lower limb only site using a controlled excision pattern and restricted pathology cohort. Method: 100 previously untreated malignant BCC's and SCC's on the lower limb were excised and measurements made of the resulting wound and the specimen removed. Measurements were subsequently made after pathologic processing and statistically compared. Results: With excision of lower limb skin tumours the surgical defect enlarges significantly (15%) and the specimen shrinks significantly (20%) in both length (12%) and width (9%). The specimen shrinks a further 11%-again shrinking in length (8%) and width (2.6%) with formalin processing. The pathology specimen is 28.6% smaller than the specimen marked for excision. Anatomical site contributes to the degree of shrinkage. The pathologic specimen is only 75% of the suture repaired wound length. Conclusions: Skin specimens shrink significantly both with excision and processing. Most shrinkage (70%) takes place with excision while the remaining 30% with processing. The shrinkage takes place disproportionately in the normal tissue component of the specimen. Age, anatomical location, and pathology appear to play a part.

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Surgical versus pathological excision margins—an excision too far?

Cited by 4 publications

References 9 publications

Skin thickness measurements increase with excision and biopsy processing procedures

Skin thickness measurements increase with excision and biopsy processing procedures

Validating the relationship between burn temperature, duration of exposure and tissue injury severity for scald burns

Skin tumour specimen shrinkage with excision and formalin fixation—how much and why: a prospective study and discussion of the literature

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