title: Reliability of skin biopsies in determining accurate tumor margins: a retrospective study after Mohs micrographic surgery.
abstract: BACKGROUND
  Skin biopsy reports of basal cell carcinoma and squamous cell carcinoma are often accompanied by comments on the margins. A physician's management can be influenced by such reports, particularly when the margins are reported as clear and no further interventions are pursued.
  
  
  OBJECTIVE
  To retrospectively review pathology margins on Mohs micrographic surgery (MMS) cases performed at a University Center and to compare biopsy margins with the Mohs margins found on the first stage.
  
  
  METHODS
  Data collection of 1,000 cases of Mohs surgery was obtained regarding margins on skin biopsy and compared with margins on the first stage of MMS.
  
  
  RESULTS
  Overall, of the biopsies that showed only deep margin involvement, a lateral margin was seen on 32% of the first stages of MMS. Conversely, of the biopsies that showed only lateral margin involvement, a deep margin was seen on 14% of the first stages of MMS. Of the biopsies that showed clear margins, a margin was seen in 30% of the cases on the first stage of MMS.
  
  
  CONCLUSIONS
  Skin biopsies processed through the "bread-loafing" technique are not reliable in detecting accurate margins, and therefore, a biopsy report should not include margin involvement within it.
authors.affiliation: *Department of Dermatology, Wayne State University, Dearborn, Michigan; †Department of Dermatology, American University of Beirut, Beirut, Lebanon; ‡Department of Internal Medicine, Clinical Research Institute at the Faculty of Medicine, American University of Beirut, New York, New York; §Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Cynthia Lynn
authors.initials: CL
authors.lastname: Koslosky
authors.forename: Abdel Kader
authors.initials: AK
authors.lastname: El Tal
authors.forename: Benjamin
authors.initials: B
authors.lastname: Workman
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Michelle Christine
authors.initials: MC
authors.lastname: Durance
authors.forename: David Ali
authors.initials: DA
authors.lastname: Mehregan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult