Histologic evaluation of tumor persistence at the surgical margins in oral cancer: an evaluation of all surgical margins using paraffin-embedded sections and its usefulness and limitations.
An evaluation of frozen sections at all surgical margins (Mohs' surgery) was attempted in three patients, in order to determine whether or not a tumor persisted at the surgical margins following surgery for carcinoma of the oral cavity. However, sectioning from the fresh tissue was difficult, and moreover, duration of the surgery was lengthened. It thus seems that this method is not suitable for a routine evaluation of the surgical margins. Based on this, surgical specimens after formalin fixation were evaluated in eight patients. The use of paraffin-embedded sections compensates the disadvantages in using frozen sections. On the other hand, when a residual tumor is detected, any additional excision should be delayed. In two patients, who were evaluated using paraffin-embedded sections, a persistent tumor was detected. In another patient a recurrent tumor developed, despite having completely tumor-free margins. In this patient, the growth of the tumor appeared to be discontinuous. When skip lesions are histologically suggested, adjuvant therapy including radiotherapy should be considered, even when a persistent tumor is not evident. A reliable evaluation of all surgical margins is difficult in either a T4 tumor or in a malignant tumor of the gingiva and hard palate. Microscopic evaluation of all surgical margins using paraffin-embedded sections is considered to be practical in helping to elucidate the microscopic extent of a tumor, although there are several limitations in its application.
Ikemura
K
K
Department of Dentistry and Oral Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Fujie
Y
Y
Ohya
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016612:Paraffin Embedding; D011237:Predictive Value of Tests; D016707:Tissue Fixation