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Factors Affecting Excisional Margin Status of Skin Tumors

By: Lauren Harrison, MS
Posted: Tuesday, December 22, 2020

Intrinsic tumor characteristics, rather than the specialty of the physician, appears to influence the success of achieving tumor-free resection margins in patients with basal cell carcinoma or melanoma in situ. Brent C. Martin, MD, of the University of California, Irvine, and colleagues published their multicenter study in Dermatologic Surgery.

This 8-year retrospective study analyzed pathology records for excision of melanoma in situ and basal cell carcinoma in 5,800 specimens from 5,217 unique patients. Margin status and tumor size were ascertained from pathology reports; researchers looked for phrases associated with positive or negative margins. Patient demographics, tumor characteristics, and provider details were compared across physician specialties.

All specimens came from 319 different health-care providers representing 4 specialties: dermatology, otolaryngology, plastic surgery, and general surgery. Most providers (91%) were physicians. Incomplete excision was seen in 23% of specimens, with no significant difference noted between basal cell carcinoma and melanoma in situ.

When the researchers looked at specialties individually, positive tumor margins were seen in 24% of excisions performed by dermatologists; 26%, by plastic surgeons; 28%, by otolaryngologists; and 12%, by general surgeons. Melanomas were more likely to be excised by general surgeons (23%) than dermatologists (7%), but no difference was seen in excision of basal cell carcinomas.

Cases handled by general surgeons tended to be larger than 2 cm, whereas 60% of all tumors included in the analysis were less than 2 cm. General surgeons were also less likely to excise tumors from the head and neck (7%) when compared with dermatologists (37%). These two variables, larger tumors and head and neck tumors, were both associated with an increased risk for incomplete excision, indicating tumor characteristics may play a more significant role in the margin status of tumors. In addition, dermatologists, plastic surgeons, and otolaryngologists all had similar rates of incomplete excision in all multivariate models.

Disclosure: The study authors reported no conflicts of interest.



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