Walker Patrick, Hill Dudley
Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Australas J Dermatol. 2006 Feb;47(1):1-12. doi: 10.1111/j.1440-0960.2006.00216.x.
SUMMARY Surgical treatment of basal cell carcinomas using postoperative histological assessment is routinely practised in Australia. The efficacy of the procedure depends on key decisions made by the surgeon. The first is case selection that requires an understanding of the limitations of the procedure. The tumour border is then identified and a margin added. The margin selected should achieve the desired balance between incomplete excision rate and mean tissue sacrifice. There is an inverse relationship between these parameters; achieving a 5% incomplete excision rate requires a mean tissue sacrifice of over 4 mm. Factors affecting margin selection are discussed, unfortunately none allows a dramatic reduction in mean tissue sacrifice. The final decision involves interpreting and acting on the histological examination of the excised specimen. Tumour recurrence is rare (less than 2% at 5 years) if the tumour is clear of the surgical margin. The visualized histological margin required to ensure complete excision varies with histological technique and tumour properties. Routine reporting of histological margin in millimetres or horizontal sectioning is recommended. Tumour recurrence averages 38% when the histological margin is involved. The merits of careful clinical follow up of incompletely excised tumours or immediate re-excision are discussed.
摘要 在澳大利亚，采用术后组织学评估进行基底细胞癌的外科治疗是常规做法。该手术的疗效取决于外科医生做出的关键决策。首先是病例选择，这需要了解该手术的局限性。然后确定肿瘤边界并增加切缘。所选切缘应在不完全切除率和平均组织牺牲之间达到理想平衡。这些参数之间存在反比关系；要实现5%的不完全切除率，平均组织牺牲需超过4毫米。文中讨论了影响切缘选择的因素，遗憾的是，没有一个因素能大幅降低平均组织牺牲。最后的决策涉及对切除标本的组织学检查结果进行解读并据此采取行动。如果肿瘤远离手术切缘，肿瘤复发很少见（5年时低于2%）。确保完全切除所需的可见组织学切缘因组织学技术和肿瘤特性而异。建议常规报告以毫米为单位的组织学切缘或水平切片情况。当组织学切缘受累时，肿瘤复发平均为38%。文中讨论了对不完全切除肿瘤进行仔细临床随访或立即再次切除的优点。
