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Soo Park, MD
Soo Park, MD
Posted: Friday, December 20, 2024
For patients with dermatofibrosarcoma protuberans, high-risk basal cell carcinoma, and very high–risk cutaneous squamous cell carcinoma, peripheral and deep en face margin assessment (PDEMA) is the recommended management strategy to obtain complete margin evaluation, according to a study published in JNCCN–Journal of the National Comprehensive Cancer Network. This recent study outlines the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) according to the Tubingen methods of PDEMA in hopes that centers will adopt them when establishing their protocols to optimize patient outcomes, explained Chrysalyne D. Schmults, MD, MSCE, of Dana-Farber/Brigham and Women’s Cancer Center, Boston, and colleagues.
The Tubingen PDEMA requires active communication between the resecting surgeon and the dermatopathologist or pathologist. The first recommended step is tumor removal, which allows for histologic analysis. This is followed by the creation of a marginal tissue disc that is inked and divided, so its orientation relative to the wound bed is preserved. Each marginal tissue block should be individually preserved, and the surgeon should design a schematic map indicating where each marginal tissue block was collected relative to the wound bed. The dermatopathologist or pathologist will then evaluate the tissue samples and discuss the findings with the surgeon, so any additional area with residual tumor tissue within the wound bed can be resected. These steps are continuously repeated until clear margins are achieved.
Not all surgical excisions will be straightforward, noted the investigators, such as cases with nerve invasion or bone resection. PDEMA may be incomplete in these situations; however, the available marginal surfaces should still be assessed using PDEMA guidelines. Clinicians are advised to use the PDEMA checklist outlined by the NCCN to ensure their surgical resection achieves PDEMA.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
JNCCN–Journal of the National Comprehensive Cancer Network
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