Schultz B C, Roenigk H H
J Am Acad Dermatol. 1982 Oct;7(4):495-9. doi: 10.1016/s0190-9622(82)70131-8.
A new technic is described for more accurately checking the surgical margins of skin tumors removed by standard surgical excision. Vertical sections of surgical specimens represent check points of the margin only 7 microns thick. This means most of the surgical margin is not checked microscopically, allowing small tumor islands at the margin to remain undetected. The technic is applicable wherever surgical excision is used to excise skin tumors. It is especially suitable for basal cell carcinoma. A variable-width knife holding two scalpel blades parallel to each other is set at 2 to 3 mm separation. When the excision is done as usual, the blades will cut a 2- to 3-mm strip of tissue representing the entire lateral borders of the excision. This specimen is easily mounted as a flat section for frozen or paraffin processing. These sections will be cut to show the entire lateral excision margin to be checked for tumor. A new punch with concentric cutting edges separated by 2 mm has been made to obtain a similar flat section. The circular defect is converted to a standard ellipse and closed primarily. This technic has the advantage of using primary closure for excellent cosmetic results. It requires little additional skill on the part of the surgeon and is easily handled by the pathology laboratory. It has been used in thirteen cases with no recurrence of tumors to date.
本文描述了一种新技术，用于更准确地检查通过标准手术切除的皮肤肿瘤的手术切缘。手术标本的垂直切片代表仅7微米厚的切缘检查点。这意味着大部分手术切缘未进行显微镜检查，从而可能导致切缘处的小肿瘤岛未被发现。该技术适用于任何采用手术切除治疗皮肤肿瘤的情况，尤其适用于基底细胞癌。使用一种可变宽度的刀，其装有两个相互平行的手术刀刀片，刀片间距设置为2至3毫米。当像往常一样完成切除后，刀片将切下一条2至3毫米宽的组织条，该组织条代表切除部位的整个外侧边界。这个标本很容易制成扁平切片用于冷冻或石蜡处理。这些切片将被切割以显示整个外侧切除切缘，用于检查肿瘤。已经制作了一种新的打孔器，其同心切割边缘间隔2毫米，以获得类似的扁平切片。圆形缺损被转换成标准椭圆形并一期缝合。该技术的优点是采用一期缝合可获得良好的美容效果。它对外科医生来说几乎不需要额外的技巧，并且病理实验室很容易处理。迄今为止，该技术已应用于13例患者，均未出现肿瘤复发。
