return to: Cancer Management Principles
see specific histologic types:
Surgical Margins for Squamous Cell Carcinoma (includes powerpoint presentation addressing margins)
Melanoma (Evaluation and Management) (8th Edition AJCC)
Surgical Margins General Concepts
Large prospective randomized trials comparing the distance of melanoma to the surgical resection edge have been performed to direct surgical treatment. Similar large prospective studies are lacking for most other cancers arising in the head and neck. Most data comes from retrospective studies and surgical experience.
Surgical margins are generally considered adequate (clear) or inadequate (involved) based on the measured distance from the cancer to the cut edge of the specimen. This analysis is compromised in the head and neck both by the complexities of the three dimensional resections as well as by tissue shrinkage in the course of processing (Johnson, Funk, Hoffman).
The adequacy of a resection is most critically analyzed by longitudinal study evaluating recurrence rates. Determination of an 'adequate resection' requires analysis of factors other than measured distances. Yang et al (2008) identified that characteristics of the invasive tumor front are important determinants in predicting cancer behavior.
Squamous Cell Carcinoma of the Skin (from Nahhas et al 2017 citing NCCN guidelines):
a. Low risk tumors: 4-6 mm peripheral margins recommended
b. For high risk (ill-defined, affecting the genitalia, mucosal surfaces, face, and/or neck) lesions >6mm in size and for moderate risk that are greater than 10 mm in size and in those penetrating to subcutaneous fat:
recommended >6 mm peripheral margins with deep margin recommendations 'do not appear to be available)
References
Yang TL, Ko JY,Chang YL: Involved margin of tongue cancer: the impact of tumor satellites on prognosis. Head & Neck 2008 Jul;30(7):845-51.
Johnson RE, Sigman JD, Funk GF, Robinson RA and Hoffman HT: Quantification of surgical margin shrinkage in the oral cavity. Head Neck. 1997 Jul;19(4):281-6
Nahhas AF, Scarbrough CA, Trotter S.A Review of the Global Guidelines on Surgical Margins for Nonmelanoma Skin Cancers.J Clin Aesthet Dermatol. 2017 Apr;10(4):37-46