Use of Intraoperative Frozen Section in the Surgical Management of Patients with Nonmelanoma Skin Cancer.

Liann Loh,O-Wern Low,Hanjing Lee,Vigneswaran Nallathamby,Thiam Chye Lim,Jingtzer Lee,Jane Lim,Priya Tiwari,Yan Lin Yap,Arash Kimyai Asadi

doi:10.1155/2021/4944570

Abstract

Background Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Objective To compare the outcome of NMSC patients with excision performed with and without IFS. Materials and Methods A retrospective, single-centre study was performed on all patients who had undergone resection of NMSC with and without IFS control at the National University Hospital (NUH) from 2010 to 2015. Results 116 patients were recruited, of which 86 had IFS and 30 did not. The complete excision rate of patients with IFS was higher at 87.2% (p=0.0194), need for secondary operation was lower at 1.2% (p=0.005), and need for postsurgery radiotherapy or chemotherapy was lower at 1.2% (p=0.001). The average duration of surgery in patients who underwent IFS was 95.4 minutes compared to 70.1 minutes in cases which did not undergo IFS. Conclusion Our study showed an increased complete excision rate and reduced need for secondary surgeries and adjuvant therapy in patients with IFS. However, a longer operative duration was required. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision.

Highlights

Nonmelanocytic skin cancer (NMSC) is one of the most common cancers in the world [1], with worldwide incidence increasing [1]. is can be attributed to factors such as increased exposure to ultraviolet light, increased outdoor activities, increased longevity, ozone depletion, and genetics [2].Skin cancer is one of the top ten most common cancers in Singapore, and local incidence is on the rise [3, 4]
Mohs micrographic surgery (MMS) is performed under local anaesthesia with the tumor being excised at an oblique angle and horizontal sections sent for microscopic evaluation of the peripheral and deep margins
A total of 116 cases were included in this retrospective study. e mean age of all patients was 71.6 years at the time of operation. ere was an even distribution of males (50%) and females (50%) selected. 74.1% (n 86) of all patients had Intraoperative frozen section (IFS) performed while 25.9% (n 30) did not (Table 1)

Summary

Introduction

Nonmelanocytic skin cancer (NMSC) is one of the most common cancers in the world [1], with worldwide incidence increasing [1]. is can be attributed to factors such as increased exposure to ultraviolet light, increased outdoor activities, increased longevity, ozone depletion, and genetics [2].Skin cancer is one of the top ten most common cancers in Singapore, and local incidence is on the rise [3, 4]. MMS allows surgeons to ensure definitive excision with minimal loss of normal surrounding tissue, thereby offering high cure rates with good cosmesis [8]. It is typically indicated in patients with aggressive malignant features such as morpheaform or sclerosing subtypes, lesions near cosmetically sensitive areas (periorbital, periauricular, and paranasal), lesions with highrisk features, poorly delineated margins in scar tissue, or recurrent tumors [9]. Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision

Results

Discussion

Conclusion