Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
Br J Dermatol. 2010 Mar;162(3):607-10. doi: 10.1111/j.1365-2133.2009.09577.x. Epub 2009 Nov 10.
Histology reports of skin tumour excisions frequently describe a histological margin significantly less than the planned surgical excision margin.
A novel method of marking visible tumour margin was devised. This allowed us to evaluate the accuracy of tumour detection and to compare tissue contraction of the clinically normal perilesional skin with that of tumour tissue following excision and fixation.
Forty-four well-defined basal cell carcinomas were excised from 42 patients. The visible tumour edge was marked by scoring with a blade around its circumference prior to excision. This allowed comparison of visible and true histological tumour margin. The excision margin was carefully measured from the scored line and the tumour excised. After tissue fixation and processing the histological dimensions of tumour and perilesional margin skin were compared with the pre-excision measurements.
The tumour edge was accurately identified to within 1 mm in 67% of margins and was underestimated in only 4%. The whole specimen contracted by a mean of 14%. Skin containing tumour contracted by a mean of 11% but adjacent tumour-free skin in the same plane contracted by a mean of 19%. There was no significant effect of age and site on difference in percentage shrinkage between tumour and margin.
We underestimated tumour extent at only 4% of margins. Tissue shrinkage was the most important factor affecting eventual histological margin. Our novel technique allowed us to demonstrate that this shrinkage is not uniform across the specimen, but is disproportionately high in the tumour-free margin. This suggests that previous estimates of margin shrinkage, based on whole-specimen contraction measurements, may have been erroneously low.
皮肤肿瘤切除的组织学报告经常描述的组织学边缘明显小于计划的手术切除边缘。
设计了一种新的标记可见肿瘤边缘的方法。这使我们能够评估肿瘤检测的准确性，并比较切除和固定后肿瘤组织和临床正常肿瘤周围皮肤的组织收缩。
从 42 名患者中切除了 44 个明确界定的基底细胞癌。在切除前，用刀片围绕其圆周对可见肿瘤边缘进行评分，从而可以比较可见和真实的组织学肿瘤边缘。从评分线仔细测量切除边缘，并切除肿瘤。组织固定和处理后，将肿瘤和肿瘤周围边缘皮肤的组织学尺寸与术前测量进行比较。
肿瘤边缘在 67%的边缘内被准确识别到 1mm 以内，仅低估了 4%。整个标本收缩了 14%。含有肿瘤的皮肤平均收缩 11%，但同一平面的相邻无肿瘤皮肤平均收缩 19%。肿瘤和边缘之间的收缩百分比差异不受年龄和部位的影响。
我们仅在 4%的边缘低估了肿瘤范围。组织收缩是影响最终组织学边缘的最重要因素。我们的新技术使我们能够证明这种收缩在整个标本中并不均匀，而是在无肿瘤的边缘中不成比例地高。这表明，以前基于整个标本收缩测量的边缘收缩估计可能被错误地低估了。
