About Excision with Frozen Section
An excision with frozen sections is a procedure in which skin cancer is removed and the tissue specimen is then frozen. Next, several cuts are made through the frozen tissue, stained with special dyes and inspected by a pathologist or dermatopathologist for tumors cells near the surgical cut margin. This process is repeated until no tumor cells are present under the microscope. There is only a 95% accuracy rate because the skin cancer is not mapped out and only isolated areas are examined. This means in about 5% of cases, tumor cells may be present a few days after the procedure and requires further treatment.
Excisional surgery with conventional frozen section margin control
Often performed in a hospital setting, this surgical procedure involves checking the pathology with frozen sections prior to closing the surgical wound. Additional tissue is removed prior to closing the wound If the tumor extends to the edges of the specimen.
Advantages and Disadvantages of Either Moh's or Rapid Frozen Section Treatment
Moh's micrographic surgery has the advantage of a more accurate initial analysis of the tissue. In areas such as the face, nose, or where preservation of skin is important for reconstruction this is especially of value. The main disadvantage of Moh's is that it might take several hours to complete or you may have days between excision (removal of skin cancer) and reconstructive surgery to close the defect. Especially in areas of the face and body which have plenty of skin available for reconstruction, Moh’s micrographic surgery is often unnecessary and time consuming.
Various Reasons for Using the Frozen Section Technique
If a tumor appears to have spread (metastasized), a sample is sent for frozen section for confirmation. This helps when determining whether there is any point in continuing the operation. Usually, surgical excision is performed only if there is a chance to remove all cancer. If the tumor has spread, a more conservative approach is taken.
If a tumor has been removed but it is unclear whether the margin (border) is clear, frozen section is used to determine if further resection is needed for clear margins.
In a sentinel lymph node biopsy, frozen section can help determine whether the sentinel node containing tumor tissue requires further lymph node dissection, while a benign node will avoid such a procedure.
History 78-year-old man with a recurrence of squamous cell carcinoma of forehead following surgery and radiation. Resection was performed in 4/2016 and radiation followed. Lesion recurred within 1 week of completion of radiation within radiation field. Originally presented with squamous cell carcinoma with perineural invasion and 4.5mm depth of invasion, arising from squamous cell carcinoma…Read More
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HISTORY 89-year-old man presents with several month history of lesion on bottom lip. A biopsy was taken on 8-9-17 and showed severe squamous atypia without ruling out deeper SCC. Excision of lesion done 9-6-17 showed invasive squamous cell carcinoma with foci of moderate squamous dysplasia from 9 to 3 o’clock. Patient has history of BCC,…Read More
History 61-year-old woman underwent Mohs excision of left forehead basal cell carcinoma on 7/11/2017. Patient developed bleeding and pain post-op day 1. A subsequent polymicrobial wound infection was treated with antibiotics. Post-op hematoma is the likely contributing factor to skin flap necrosis. All ischemic tissue has self-debrided without surgical intervention. Patient is seeking reconstructive options.…Read More
HISTORY 61-year-old woman presents with several year history of pigmented left cheek and lower lid lesion. She was initially treated with liquid nitrogen 15 months ago. A biopsy was performed 6-8-17 and revealed melanoma in situ. Excision with close margins performed 6-16-17. Clear margins found on LPMG reading. Second opinion from UCSD was suspicious for…Read More
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