[Study of skin retraction applied to the treatment of skin tumors. Mapping of the human body]

Retraction of cutaneous specimens: tumours and margins after surgical excision

AIMS

In previous studies, skin retraction of dermato-pathological specimens after the surgical excision of tumours was calculated at 30% for the surface, with approximately 20% for the length and 15% for the width. The aim of this study was to analyse the retraction of the specimens and the retraction of the lesion and the margins.

METHODS

Patients who underwent excision of a skin tumour between January 2013 and July 2014 were randomly included.

RESULTS

A total of 104 patients was included. There were 52% male with a mean age of 68.3 years. Seventy-eight per cent of the lesions were malignant (51% were basal cell carcinoma, 10% squamous cell carcinoma). The retraction of the area of the specimen (29%) was significantly greater than the retraction of the tumour (21%). On multivariate analysis, the localisation and the duration of fixation were independent predictors of the specimen area retraction. The retraction of the specimen was 17% in length and 15% in width. The retraction of the margins was calculated at 19% in length and 12% in width. The surgeon correctly evaluated the localisation of the smallest margin in 55% of cases.

CONCLUSIONS

Our study provided additional data regarding the retraction of the tumours and margins. The guidelines for surgical excision of skin cancers recommend a clinical margin before excision, but the evaluation of the sufficiency of the margins is based on histological measurement. Our data are useful for the interpretation of the sufficiency of the margins.

[Skin shrinkage study for skin oncologic surgery. Clinical study of 79 cases]

BACKGROUND

Skin tumors surgery is common and well established. There is discrepancy between recommendations on macroscopic margins to apply and therapeutic decisions taken on histological margins. The purpose of this study is to examine skin shrinkage upon exeresis, then in formalin, to understand the anatomo-clinical discrepancy, which is often found.

MATERIAL AND METHODS

It was a prospective study, lasting a month, including patients receiving skin surgery. For each tumor, the surgeon carried out 4 margins measurements before and after exeresis ; margins measured again in histology. The evaluation criterion was the difference between preoperative, postoperative and histological margins measurement. These data was weighting according to factors linked to the patient and the tumor.

RESULTS

Seventy-nine tumors for 61 patients had been studied. The study showed a significant shrinkage between preoperative measurements and postoperative, from 0.4 to 0.6mm. It is correlated with no one tested factors. Significant shrinkage between 0.4 and 0.5mm was also established between preoperative and histological measurements. However, there is a significant augmentation between postoperative and histological measurements.

CONCLUSION

This last result could be linked to the inflammatory peri-wound skin that surgeon consider as tumoral process so exclude of his margin, while histology could show a healthy area. In front of these results, an expert committee leading a more important study could include histological margins recommendations to the actual clinical recommendations.

Study of shrinkage of cutaneous surgical specimens

BACKGROUND

The assessment of discrepancies between surgical and histopathological measurements of specimens is important in order to avoid repeat surgery and unnecessary follow-ups.

OBJECTIVES

The objective of this study was to quantify the degree, time and influential factors of shrinkage of cutaneous surgical specimens.

METHODS

Data of 111 patients were gathered on age, sex, localization, diagnosis and specimen width and length before surgical excision (in vivo), at 5 min postsurgery (ex vivo) and after 24 h of fixation in 10% buffered formalin (postfixation).

RESULTS

The length and width were significantly lower in the postfixation vs. in vivo specimens, with a mean shrinkage of 17.0% in the length (p < 0.01) and 9.5% in the width (p < 0.01). 81.8% and 92.3% of the total shrinkage in length and weight was observed between in vivo and ex vivo measurements. No significant differences were observed as a function of sex, age or diagnosis. A greater shrinkage in length between in vivo and postfixation was found in specimens from the trunk.

LIMITATIONS

The most of the skin samples were diseased.

CONCLUSION

The largest proportion of specimen shrinkage occurred within 5 min of its excision and the shrinkage was greater in specimens from the trunk.