Gross processing of skin excisions - Revision history

Mikael Häggström: /* Radicality slices */ the

2022-04-22T11:53:11Z

Radicality slices: the

← Older revision		Revision as of 07:53, 22 April 2022
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	<gallery heights=240px>		<gallery heights=240px>
	File:Tissue selection from skin excision with narrow margin and lens shape.png\|One more slice towards tip in this example.		File:Tissue selection from skin excision with narrow margin and lens shape.png\|One more slice towards tip in this example.
	File:Tissue selection from skin excision with narrow margin and oval shape.png\|If insufficient material for additional radicality slices, make multiple step sections from submitted one.		File:Tissue selection from skin excision with narrow margin and oval shape.png\|If insufficient material for additional radicality slices, make multiple step sections from the submitted one.
	</gallery>		</gallery>

Mikael Häggström: Expanded

2021-10-14T23:25:58Z

Expanded

← Older revision		Revision as of 19:25, 14 October 2021
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	===Lens-shaped excisions===		===Lens-shaped excisions===
	Also called marquise ("lens" or "boat") shape.		Also called marquise ("lens" or "boat") shape.<ref group=notes>An "elliptical" skin excision is technically an oval, but the term is often used for marquise-shaped excisions as well.</ref>
	{{Gross processing of skin excisions\|header= }}		{{Gross processing of skin excisions\|header= }}
	===Oval excisions===		===Oval excisions===
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	Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the first one shows tumor cells. However, if tumor cells are found near the resection margins on the radicality slices, non-radicality cannot be excluded by additional sampling towards the tips.		Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the first one shows tumor cells. However, if tumor cells are found near the resection margins on the radicality slices, non-radicality cannot be excluded by additional sampling towards the tips.

			===Gross margin measurements===
			These are generally not needed, unless the skin excision is big enough to not conveniently include both the lesion and the nearest margin.

	===Wounds===		===Wounds===

Mikael Häggström: Comprehensive

2021-04-16T14:49:28Z

Comprehensive

← Older revision		Revision as of 10:49, 16 April 2021
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			{{Comprehensiveness}}
	==Frozen sections==		==Frozen sections==
	Melanocytic lesions will look atypical by artifacts on frozen sections, limiting its value in for example clearing margins.		Melanocytic lesions will look atypical by artifacts on frozen sections, limiting its value in for example clearing margins.

	==Submission of entire specimen==		==Submission of entire specimen==
	Serial sectioning and submission of the entire specimen is recommended when a lesion is ~~not~~ grossly visible.<ref name="SinghRanjan2014">{{cite journal\|last1=Singh\|first1=ManojKumar\|last2=Ranjan\|first2=Richa\|last3=Singh\|first3=Lavleen\|last4=Arava\|first4=SudheerK\|title=Margins in skin excision biopsies: Principles and guidelines\|journal=Indian Journal of Dermatology\|volume=59\|issue=6\|year=2014\|pages=567\|issn=0019-5154\|doi=10.4103/0019-5154.143514}}</ref>		Serial sectioning and submission of the entire specimen is recommended when the referral or clinical history indicates a pertinent lesion, but no lesion is grossly visible.<ref name="SinghRanjan2014">{{cite journal\|last1=Singh\|first1=ManojKumar\|last2=Ranjan\|first2=Richa\|last3=Singh\|first3=Lavleen\|last4=Arava\|first4=SudheerK\|title=Margins in skin excision biopsies: Principles and guidelines\|journal=Indian Journal of Dermatology\|volume=59\|issue=6\|year=2014\|pages=567\|issn=0019-5154\|doi=10.4103/0019-5154.143514}}</ref>

	{{~~Moderate~~-begin}}Also, submit the entire specimen for suspected malignant skin excisions when the distance from the lesion edge to the tip does not exceed about 2-3 cm in either direction. Have a longer threshold for suspected melanomas.{{~~Moderate~~-end}}		{{Comprehensive-begin}}Also, submit the entire specimen for suspected malignant skin excisions when the distance from the lesion edge to the tip does not exceed about 2-3 cm in either direction. Have a longer threshold for suspected melanomas.{{Comprehensive-end}}

	==Partial submission of specimen==		==Partial submission of specimen==

Mikael Häggström: /* Submission of entire specimen */ Expanded

2021-04-16T14:46:25Z

Submission of entire specimen: Expanded

← Older revision		Revision as of 10:46, 16 April 2021
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	==Submission of entire specimen==		==Submission of entire specimen==
	~~Recommended~~ when a lesion is not grossly visible.<ref name="SinghRanjan2014">{{cite journal\|last1=Singh\|first1=ManojKumar\|last2=Ranjan\|first2=Richa\|last3=Singh\|first3=Lavleen\|last4=Arava\|first4=SudheerK\|title=Margins in skin excision biopsies: Principles and guidelines\|journal=Indian Journal of Dermatology\|volume=59\|issue=6\|year=2014\|pages=567\|issn=0019-5154\|doi=10.4103/0019-5154.143514}}</ref> Also, the entire specimen ~~may be sliced and submitted if~~ the ~~risk of malignancy is high~~.~~<ref name=processing/>~~		Serial sectioning and submission of the entire specimen is recommended when a lesion is not grossly visible.<ref name="SinghRanjan2014">{{cite journal\|last1=Singh\|first1=ManojKumar\|last2=Ranjan\|first2=Richa\|last3=Singh\|first3=Lavleen\|last4=Arava\|first4=SudheerK\|title=Margins in skin excision biopsies: Principles and guidelines\|journal=Indian Journal of Dermatology\|volume=59\|issue=6\|year=2014\|pages=567\|issn=0019-5154\|doi=10.4103/0019-5154.143514}}</ref>

			{{Moderate-begin}}Also, submit the entire specimen for suspected malignant skin excisions when the distance from the lesion edge to the tip does not exceed about 2-3 cm in either direction. Have a longer threshold for suspected melanomas.{{Moderate-end}}

	==Partial submission of specimen==		==Partial submission of specimen==

Mikael Häggström: /* Inking */ Added alternative

2021-04-16T14:41:35Z

Inking: Added alternative

← Older revision		Revision as of 10:41, 16 April 2021
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	==Inking==		==Inking==
	[[File:Grossing of suspected malignant skin excision.jpg\|thumb\|~~Inking~~ of a suspected malignant skin excision with orienting needles.]]		[[File:Grossing of suspected malignant skin excision.jpg\|thumb\|Minimal inking of a suspected malignant skin excision with orienting needles.]]
	If the sample is marked with one or more sutures or colored nails, perform [[inking]] of one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref> For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>		If the sample is marked with one or more sutures or colored nails, perform [[inking]] of one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref>

			The example at right shows a minimal amount of ink colors, necessitating that each radicality slice is submitted in a separate cassette.

			[[File:Inking of an oriented skin ellipse in gross pathology.jpg\|thumb\|center\|250px\|Example with 5 different inks: Each tip (in this case 3 o'clock or lateral and 9 o'clock or medial) is inked differently (in this case yellow and red) to allow submission in a single cassette. Also, the deep margin is inked differentially (black in this case).]]

			For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>

	==Report==		==Report==

Mikael Häggström: /* Inking */ Linked

2021-04-15T12:27:51Z

Inking: Linked

← Older revision		Revision as of 08:27, 15 April 2021
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	==Inking==		==Inking==
	[[File:Grossing of suspected malignant skin excision.jpg\|thumb\|Inking of a suspected malignant skin excision with orienting needles.]]		[[File:Grossing of suspected malignant skin excision.jpg\|thumb\|Inking of a suspected malignant skin excision with orienting needles.]]
	If the sample is marked with ~~a suture~~ or colored nails, ~~apply ink (such as India ink) to~~ one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref> For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>		If the sample is marked with one or more sutures or colored nails, perform [[inking]] of one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref> For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>

	==Report==		==Report==

Mikael Häggström: /* Partial submission of specimen */ If calciphylaxis

2021-03-04T18:28:22Z

Partial submission of specimen: If calciphylaxis

← Older revision		Revision as of 14:28, 4 March 2021
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	Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the first one shows tumor cells. However, if tumor cells are found near the resection margins on the radicality slices, non-radicality cannot be excluded by additional sampling towards the tips.		Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the first one shows tumor cells. However, if tumor cells are found near the resection margins on the radicality slices, non-radicality cannot be excluded by additional sampling towards the tips.

			===Wounds===
			Measure both the area and depth of the wound (if applicable). Take a radial section of the wound, including adjacent viable tissue. Radicality is not important unless specifically requested. If calciphylaxis is included as a target, sample approximately 1 slice per cm of tissue.

	==Inking==		==Inking==

Mikael Häggström: +Atypical

2020-11-04T00:36:01Z

+Atypical

← Older revision		Revision as of 20:36, 3 November 2020
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	}}		}}

			==Frozen sections==
			Melanocytic lesions will look atypical by artifacts on frozen sections, limiting its value in for example clearing margins.

	==Submission of entire specimen==		==Submission of entire specimen==

Mikael Häggström: /* Inking */ +Image

2020-03-11T16:06:15Z

Inking: +Image

← Older revision		Revision as of 12:06, 11 March 2020
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	==Inking==		==Inking==
			[[File:Grossing of suspected malignant skin excision.jpg\|thumb\|Inking of a suspected malignant skin excision with orienting needles.]]
	If the sample is marked with a suture or colored nails, apply ink (such as India ink) to one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref> For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>		If the sample is marked with a suture or colored nails, apply ink (such as India ink) to one or both of the sides, from one tip to another, and document how the inking relates to any markings before removing them.<ref name=stora>{{Stora utskärningen}}</ref> For wedge-shaped skin excisions, apply ink to both surgical edges.<ref name=svfp-skin/>

Mikael Häggström: /* Re-excisions */ Templated

2020-02-11T08:50:30Z

Re-excisions: Templated

← Older revision		Revision as of 04:50, 11 February 2020
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	==Re-excisions==		==Re-excisions==
	~~[[File:Tissue selection from~~ skin re-excisions~~.png\|245px\|right]]~~		{{Gross processing of skin re-excisions}}
	~~Depending on radicality of previous excision:~~
	*Previously radical (including thin margins): Submit at least one central section across the surgical scar.<ref name=Lundmark/>
	*Previously non-radical:
	~~:*Visible lesion: Submit the entire scar.<ref name=Lundmark/>~~
	~~:*Lesion not visible: At least one additional radicality slice towards the tips, up to the entire specimen.<ref>{{NU Hospital Group~~}}~~</ref>~~
	{{Bottom}}		{{Bottom}}