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Multibladed Knife for Staged Surgical Margin Control in Nonmelanoma Skin Cancer

2008; Lippincott Williams & Wilkins; Volume: 121; Issue: 5 Linguagem: Inglês

10.1097/prs.0b013e31816b1986

1529-4242

T Minsue Chen, Rungsima Wanitphakdeedecha, Tri H. Nguyen,

Reconstructive Facial Surgery Techniques

Sir: We read with interest the communication entitled “Bull’s-Eye Technique to Clear Margins in Nonmelanoma Skin Cancer,” by Clayman and Clayman.1 The authors describe concentric excision by holding “two scalpels together to perform this technique with more efficiency.” In our Mohs micrographic surgery practice, we utilize a similar technique in selected large, histologically aggressive, and/or recurrent tumors. In contrast to Clayman and Clayman, we utilize a multibladed knife (Fig. 1, left), such as one used for hair transplant donor harvesting. This instrument provides adjustable and consistent concentric margin width without the potential instability of holding two scalpel handles together. With this instrument, shallow incisions are made in the skin. We then revert to a single scalpel to deepen the excision.Fig. 1.: Multibladed knife (left) to create a perimeter of consistent width (right).Depending on the oncologic treatment goals, the lesion may be removed en bloc and processed for histologic margin control (i.e., Mohs micrographic technique, routine frozen-tissue sections, and formalin-fixed tissue sections). Alternatively, a staged approach may be indicated. The perimeter (Figs. 1 and 2) is removed to address the superficial margin first. When cleared, the central portion is excised to evaluate the deep surgical margin.Fig. 2.: Staged surgical margin evaluation. The perimeter was removed (as shown in Fig. 1) and stapled closed. Based on first-stage histologic findings, a second peripheral margin (marked with gentian violet) was required for oncologic cure.This technique may be utilized to facilitate surgical margin evaluation of selected tumors, especially those that may require multidisciplinary care. The Mohs surgeon can clear the superficial margin, and the surgical oncologist and pathologists can follow up to ensure deep surgical margin integrity and oncologic cure. T. Minsue Chen, M.D. Mohs and DermaSurgery Unit Department of Dermatology University of Texas—M. D. Anderson Cancer Center Houston, Texas Rungsima Wanitphakdeedecha, M.D., M.A., M.Sc. Department of Dermatology Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok, Thailand Tri H. Nguyen, M.D. Mohs and DermaSurgery Unit Department of Dermatology University of Texas—M. D. Anderson Cancer Center Houston, Texas