Contribution of the pathology examination in the operating theatre in patients with skin cancer: retrospective analysis of 388 patients

• Published in: Revue de stomatologie et de chirurgie maxillo-faciale Vol. 107; no. 2; pp. 75 - 79
• Main Authors: Dumont, T, Simon, E, Garnier, B, Sellal, S, Stricker, M, Chassagne, J F
• Format: Journal Article
• Language: French
• Published: France 01-04-2006
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma - pathology; Carcinoma - surgery; Carcinoma, Basal Cell - pathology; Carcinoma, Basal Cell - surgery; Dentistry; Eyelid Neoplasms - pathology; Eyelid Neoplasms - surgery; False Negative Reactions; Female; Humans; Male; Microsurgery; Middle Aged; Mohs Surgery; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Nose Neoplasms - pathology; Nose Neoplasms - surgery; Operating Rooms; Reoperation; Retrospective Studies; Skin Neoplasms - pathology; Skin Neoplasms - surgery
• ISSN: 0035-1768

Pathological examination in the operating theatre in patients undergoing resection of a skin cancer is one of the most adapted therapeutic approaches. We present our experience with 388 patients, comparing the rate of recurrence with or without operating-theatre pathological examination.
The study population included 388 patients, mean age 69.5 years (28-98 years) who underwent resection of 544 skin tumors (520 primary and 36 recurrent), 76.6% unique tumors. The pathological examination of the surgical specimen was performed immediately after removal. This method was systematic procedure for spinocellular carcinomas, was not performed for basocellular carcinomas measuring less than 1 cm when well circumscribed and not peri-orifice, and when reconstruction was not planned.
The pathological examination was not performed in the operative theatre for 76 tumors; for 470 examinations performed in the operative theatre, at least one surgical margin was positive in 93 (19.8%). Anatomic regions concerned most were the tip of the nose and the eyelids. Recurrent tumors (5.0% of resections) accounted for 27% of the positive pathological results. Thirty-one patients had to have revision surgery, four after a false negative on the pathological examination performed in the operative theatre, four patients for a healing problem and 23 because of tumor recurrence (4%).
Pathological examination in the operative theatre can help decrease the rate of recurrence in comparison with classical surgery using empiric margins. This method is reliable if performed by an experienced pathologist so that reconstruction can be undertaken before the definitive pathological results are obtained, improving patient comfort. These therapeutic options have a cost however in terms of equipment and personnel. Indications should be well chosen and balanced against the advantages of a two-phase classical procedure.