Relation between size of skin excision, wound, and specimen

Hudson-Peacock, Mark J.; Matthews, J. N. S.; Lawrence, C.M.

doi:10.1016/0190-9622(95)91341-6

Cited by 58 publications

(88 citation statements)

References 8 publications

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“…39 We focused instead on the number of MMS layers because layers were uniform, were less dependent on preoperative size, and could be compared between sites more consistently than postoperative size. 17 Because our study focused on cases from a single surgeon, there was consistency in technique. For tumors of larger size or aggressive histologic type, where classic teaching recommends larger layers, this method actually underestimates subclinical spread such that any risk factors still identified are even less likely to be spurious.…”

Section: Commentmentioning

confidence: 99%

“…Preoperative size was based on measurements of the largest diameter of each tumor taken using a millimeter ruler. Postoperative defects of MMS were also measured but were not used in the final analysis because previous studies 17 had demonstrated wide variability of tissue stretch in different anatomic locations. Preoperative size was analyzed according to the following categories: less than 5, 5 to 9, 10 to 14, 15 to 19, 20 to 24, and 25 mm and greater.…”

Section: Medical Chart Reviewmentioning

confidence: 99%

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Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Batra¹

2002

Arch Dermatol

158

130

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Background: In nonmelanoma skin cancer, the clinically visible portion may represent a small fraction of microscopic tumor spread. Previous studies have examined individual risk factors for subclinical spread based on patient and tumor characteristics. However, these risk factors have not been prioritized or studied in combination.Objective: To identify the most predictive risk factors for extensive subclinical tumor spread.Design: Retrospective analysis of 1131 Mohs micrographic surgical cases. Variables analyzed included patient age, sex, and immune status and lesion size, location, histologic subtype, and recurrence. Logistic regression was applied to identify important combinations of tumor characteristics and to quantify relative odds of spread.Setting: Academic referral center.Patients: Consecutive sample of all referred patients treated by a single Mohs micrographic surgeon in a 3-year period.Main Outcome Measure: Number of Mohs micrographic surgical layers required to clear a tumor, with 3 or more layers defined as extensive subclinical spread.Results: The highest-risk tumors, with odds ratios greater than 6.0, were basosquamous and morpheaform basal cell carcinoma (BCC) on the nose, morpheaform BCC on the cheek, and those with a preoperative size greater than 25 mm. Other important risk factors were recurrent and nodular BCC on the nose; location on the eyelid, temple, or ear helix; neck tumors and recurrent BCC in men; and tumor size greater than 10 mm. Patients younger than 35 years were at lower risk. Increasing age and immunocompromise were not significant predictors. Conclusion:Identification of lesions likely to exhibit extensive subclinical spread can help guide management to ensure complete tumor eradication and thereby reduce the risk of recurrence and its associated morbidity and cost.

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Section: Commentmentioning

confidence: 99%

Section: Medical Chart Reviewmentioning

confidence: 99%

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Batra¹

2002

Arch Dermatol

158

130

View full text Add to dashboard Cite

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“…There is some argument as to which steps in the tissue processing confer shrinkage and expansion but most studies support that the majority of the shrinkage occurs immediately after the biopsy procedure, probably due to contractile properties of the tissue and collapse of blood and lymph vessels, and that the subsequent formalin fixation and paraffin infusion actually expand the tissue somewhat. Thus, in spite of conflicting reports, most studies demonstrate an overall shrinkage of specimens following formalin fixation [17,18,39]. This issue is relevant for all quantitative in vitro studies of the skin and should be considered when interpreting the results of such studies.…”

Section: Discussionmentioning

confidence: 99%

“…Ex vivo techniques based on microscopic visualization of tissue specimens following preparation have the advantage of high resolution and unlimited depth of imaging in skin samples. However, it is well known that the proportions of the tissue samples are distorted in the preparation process due to contraction of the skin following biopsy and in the process of dehydration and subsequent infiltration with paraffin of tissue samples for standard light microscopy [17,18,19]. …”

Section: Introductionmentioning

confidence: 99%

Stereological Estimation of Epidermal Volumes and Dermo-Epidermal Surface Area in Normal Skin

Kamp

Balkert²,

Stenderup³

et al. 2011

Dermatology

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Quantitative morphological studies of the healthy epidermis are essential in providing a range of parameter estimates that can be considered within the range of normality. Stereology is a set of statistical tools that provides potentially unbiased and precise estimates of 3-dimensional tissue characteristics from 2-dimensional sections. We set out to establish reference values for the volume of the viable epidermis contained within a four-millimetre punch biopsy (V_epi), the volume of the stratum corneum (V_SC) and the surface area of the dermo-epidermal junction(A_DEJ) in 4 predetermined body regions by use of stereology. Four-millimetre punch biopsies were taken from 20 freshly diseased corpses, fixed in formalin and embedded in paraffin. V_epi, V_SC and A_DEJ were established stereologically for all 4 body locations followed by pairwise comparison of means after Bonferroni correction. V_epi was significantly larger in the sole compared to all other body locations (p < 0.01). Furthermore, linear regression analysis showed a strong linear relationship between V_epi and V_SC in the sole (r = 0.70). Our results suggest that the viable layers of the epidermis might also serve a mechanical function, either directly or by providing the stratum corneum with keratinocytes to support the hyperkeratosis in the weight-bearing parts of the skin.

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“…However, this may waste normal tissue, and can also induce poor outcomes in both the wound length and direction, as the operator plans the length and the direction of the wound prior to excision. In the literature, it has been mentioned that significant differences among planned excisions, wounds, and specimen sizes can be influenced by the patient’s age and the lesion site and type [7]. In addition, as the formation of dog ears is affected by several factors – tissue dynamics, wound geometry, surface contours, and surgical technique [8,9,10]– it is not ideal to commit to sacrificing normal tissues before knowing the size and shape of wound defects.…”

Section: Discussionmentioning

confidence: 99%

Round Excisions Lead to Shorter Scars and Better Scar Positioning than Traditional Elliptical Excisions

Seo¹,

Son²,

Kim³

2008

Dermatology

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Background: As traditional elliptical excisions for skin tumors are designed before surgery, they may waste normal tissue and result in poor outcome, both in terms of the wound length and direction. Objective: To compare the predicted results of elliptical excisions with scars resulting from round excisions with dog ear repairs. Methods: Forty-one patients with skin tumors were prospectively studied. Each lesion was examined and an optimal ellipse was designed and marked on the skin. Only the lesion and the required margin of adjacent skin were excised and closed with dog ear repairs. Precise measurements were conducted at each step. Results: Although many of the lesions required 2 dog ear repairs (59%), the overall sutured wound length was 14% shorter, and the wound direction differed from that of the predicted ellipse in 22% of cases. The shortening effect was distinctive in areas of thick skin, such as the trunk and scalp. Only 3 lesions resulted in a longer final wound length. In total, 29% of the patients required 1 dog ear repair and 12% needed no dog ear repairs. Conclusion: Round excisions with dog ear repairs should be considered prior to traditional elliptical excision as a more beneficial method of skin tumor removal.

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Relation between size of skin excision, wound, and specimen

Cited by 58 publications

References 8 publications

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Stereological Estimation of Epidermal Volumes and Dermo-Epidermal Surface Area in Normal Skin

Round Excisions Lead to Shorter Scars and Better Scar Positioning than Traditional Elliptical Excisions

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