Department of Dermatology, University of California, Irvine, California.
AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado.
Dermatol Surg. 2021 Feb 1;47(2):184-188. doi: 10.1097/DSS.0000000000002648.
The primary endpoint for surgical excision of skin cancer is the positive margin status. Tumor characteristics may explain much of this risk, but other important factors can include physician specialty.
To determine the variables affecting the success of a basal cell carcinoma (BCC) or melanoma in situ (MIS) excision.
METHODS/MATERIALS: An 8-year, multicenter, retrospective study of 5,800 BCC or MIS excisions performed at 13 different Kaiser Permanente medical centers. The margin status was determined by searching final pathology diagnosis texts for phrases associated with positive margins.
An incomplete excision rate was found in 23% of all specimens (BCC-22%, MIS-25%). Per specialty, the proportion of specimens with positive tumor margins was 24% for dermatology, 26% for plastic surgery, 28% for otolaryngology, and 12% for general surgery. General surgeons most often excised large tumors and tumors from truncal regions, 2 variables conferring lower odds of an incomplete excision. For non-Mohs procedures, dermatologists were no different than otolaryngologists or plastic surgeons in performing an incomplete BCC or MIS excision in all multivariate models (all p > .05).
Intrinsic tumor characteristics may influence the success of achieving tumor-free resection margins more than the specialty of the provider.
皮肤癌手术切除的主要终点是切缘阳性状态。肿瘤特征可能解释了大部分风险，但其他重要因素还包括医生的专业。
确定影响基底细胞癌（BCC）或原位黑色素瘤（MIS）切除成功的变量。
方法/材料：这是一项为期 8 年、多中心、回顾性研究，涉及 13 个不同 Kaiser Permanente 医疗中心的 5800 例 BCC 或 MIS 切除术。通过搜索最终病理诊断文本中与阳性切缘相关的短语来确定切缘状态。
所有标本中不完全切除率为 23%（BCC-22%，MIS-25%）。按专业划分，皮肤科标本的肿瘤阳性切缘比例为 24%，整形外科为 26%，耳鼻喉科为 28%，普通外科为 12%。普通外科医生最常切除大肿瘤和躯干区域的肿瘤，这两个变量降低了不完全切除的可能性。对于非 Mohs 手术，在所有多变量模型中，皮肤科医生与耳鼻喉科医生或整形外科医生在不完全切除 BCC 或 MIS 方面没有差异（均 p>.05）。
内在肿瘤特征可能比提供者的专业更能影响实现无肿瘤切除边缘的成功率。
