Reliability of skin biopsies in determining accurate tumor margins: a retrospective study after Mohs micrographic surgery.

Abstract

Skin biopsy reports of basal cell carcinoma and squamous cell carcinoma are often accompanied by comments on the margins. A physician's management can be influenced by such reports, particularly when the margins are reported as clear and no further interventions are pursued. To retrospectively review pathology margins on Mohs micrographic surgery (MMS) cases performed at a University Center and to compare biopsy margins with the Mohs margins found on the first stage. Data collection of 1,000 cases of Mohs surgery was obtained regarding margins on skin biopsy and compared with margins on the first stage of MMS. Overall, of the biopsies that showed only deep margin involvement, a lateral margin was seen on 32% of the first stages of MMS. Conversely, of the biopsies that showed only lateral margin involvement, a deep margin was seen on 14% of the first stages of MMS. Of the biopsies that showed clear margins, a margin was seen in 30% of the cases on the first stage of MMS. Skin biopsies processed through the "bread-loafing" technique are not reliable in detecting accurate margins, and therefore, a biopsy report should not include margin involvement within it.