A systematic review of surgical margins utilized for removal of cutaneous mast cell tumors in dogs

Abstract

Background: Traditionally, wide lateral surgical margins of 3 cm and one fascial plane deep have been recommended for resection of canine cutaneous mast cell tumor (MCT). Several studies have been published assessing surgical margins of less than this traditional recommendation. The objective of this systematic review was to determine if resection MCT with lateral surgical margins < 3 cm results in low rates of incomplete resection and local tumor recurrence. Systematic searches of digital bibliographic databases were performed with two authors (AR & LES) screening abstracts to identify relevant scientific articles. Studies regarding surgical treatment of dogs with cutaneous MCT were reviewed. Data abstraction was performed and the quality of individual studies and the strength of the body of evidence for utilization of surgical margins < 3 cm for removal of MCTs was assessed. Results: From the initial 78 citations identified through the database searches, four articles were retained for data abstraction after both relevance screenings were performed. Two studies were retrospective observational studies, one was a prospective case series and one was a prospective clinical trial. Assessment of the quality level of the body of evidence identified using the GRADE system was low. Excision of MCT at 2 cm and 3 cm was associated with comparably low rates of incomplete excision and recurrence. Conclusions: Despite the low quality of the overall body of evidence, a recommendation can be made that resection of canine cutaneous MCTs (< 4 cm) of Patnaik grade I and II with 2 cm lateral margins and 1 fascial plane deep results in low rates of incomplete excision and local tumor recurrence.

Malignancy prediction of cutaneous and subcutaneous neoplasms in canines using B-mode ultrasonography, Doppler, and ARFI elastography

“…It was possible to identify the signs of invasiveness in adjacent tissues because of their reactivity or the difficult tumors delimitation and then associate it with malignancy. This association is justified because malignant neoplasms tend to be more aggressive and invasive than benign ones, even requiring a greater safety margin when surgically removed [ 21 ].…”

Diagnosis, Prognosis and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors

“…The concept initially consisted of using a lateral margin proportional to the largest tumor diameter, for tumors below 4 cm, and a fixed margin of 4 cm for tumors above this diameter, maintaining a deep margin of at least one fascial plane [ 150 ]. Later, the concept was adapted, with a 2 cm lateral and a deep safety margin of a fascial plane being recommended for grade 1 or 2 tumors, and up to 4 cm in diameter, providing effective local control of the disease [ 151 , 152 , 153 , 154 ], with a recurrence rate of 0–4% [ 82 , 150 , 155 ]. In cases of high-grade (or grade 3) MCTs, there is a high recurrence rate (36%) regardless of the surgical margins used, as observed in the study by Donelly et al [ 156 ].…”

Tigilanol Tiglate-Mediated Margins: A Comparison With Surgical Margins in Successful Treatment of Canine Mast Cell Tumours

“…For our comparison of TT-mediated margins with surgical margins that would have been theoretically applied to treatment of the same tumour, we selected (i) aggressive 3 cm margins because they are widely used in general veterinary practise ( 11 – 17 , 19 , 22 , 23 ) and (ii) the more recently developed modified proportional margins method with a 2 cm limit ( 20 ) as a more conservative approach, which causes less local tissue disruption and which is gaining traction in veterinary practise. Our results suggest that there would have been significantly less local tissue disruption associated with TT than with these surgical approaches for most dogs in this study, especially for MCTs <2 cm 3 in volume, which comprised 80% of the tumours in the study population.…”

“…For comparisons with surgical margins for MCTs, we selected 3 cm margins as an example of the commonly used aggressive wide surgical approach (11)(12)(13)(14)(15)(16)(17)(18)(19), together with the recently developed modified proportional margin strategy with a 2 cm upper limit (20). In calculating the theoretical proportional surgical margins, we followed the methods described by Saunders et al, (20) and used the largest diameter of each individual tumour at the time of treatment.…”