Bull???s-Eye Technique to Clear Margins in Nonmelanoma Skin Cancer

Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review

“…8–16,18–21,25,26,28–31,33,36,38,39,41,44–64 Authors of 13 studies defined conservation of tissue as the fewest number of sections to obtain a complete margin, 8,10,20,28,29,36,41,45,49,50,58,59,64 whereas others defined it as tissue conserved by minimizing the thickness or depth of an excised layer ( n = 9), 12–15,26,31,46,59,62 minimizing tissue manipulation ( n = 8), 11,18,21,25,33,44,52,56 minimizing ambiguity of specimen margins ( n = 3), 38,48,51 minimizing “drying” up or “crumbling” of samples ( n = 3), 28,30,53 and minimizing unnecessary skin excisions preoperatively or postoperatively ( n = 5). 26,55,57,59,61 Investigators for 11 studies assessed conservation of tissue with reference to histologic “complete margins.” 9–14,16,19,46,48,60 However, the definition of “complete margins” differed greatly between studies. When percentages were used to histologically define a “complete margin,” values ranged from 85% to 100% ( n = 7).…”

“…8,10,20,28,29,36,41,45,49,50,58,59,64 In these cases, the definition of complete margin varied between studies, with values anywhere from 85% to 100% used to describe as a complete margin. [9][10][11]13,14,46,60 Other studies involved the definition of tissue conservation as minimizing the depth of an excised layer [12][13][14][15]26,31,46,59,62 or decreasing tissue waste by minimizing tissue manipulation, 11,18,21,25,33,44,52,56 ambiguity of specimen margins, 38,48,51 and "drying" up or "crumbling" of samples. 28,30,53 Ultimately, there was no uniform manner by which these new techniques, alternative devices, and mathematic models measured tissue conservation.…”

“…In most of the studies, tissue conservation was a primary outcome. 8–16,18–21,25,26,28–31,33,36,38,39,41,44–64 Conservation of tissue was defined in a multitude of ways, most commonly as the fewest number of sections to obtain a complete margin. 8,10,20,28,29,36,41,45,49,50,58,59,64 In these cases, the definition of complete margin varied between studies, with values anywhere from 85% to 100% used to describe as a complete margin.…”

“…26,55,57,59,61 Investigators for 11 studies assessed conservation of tissue with reference to histologic "complete margins." [9][10][11][12][13][14]16,19,46,48,60 However, the definition of "complete margins" differed greatly between studies. When percentages were used to histologically define a "complete margin," values ranged from 85% to 100% (n 5 7).…”

“…[9][10][11]13,14,46,60 In 29 studies, methodologic changes for histological processing were evaluated. These studies referenced alterations to techniques to conserve tissue, [11][12][13]18,20,21,25,[28][29][30]36,44,47,48,[50][51][52][53][54][55][56][57][58][59][60]64 such as a one-stage technique to combine multiple steps of the traditional MMS processing, that is combining freezing and chuck attachment in one step 8 and the use of different incision methods to prevent removal of uninvolved tissue. 38,63 In addition, investigators from 15 studies assessed new devices' ability to conserve tissue during processing.…”