Gross processing of skin excisions: Difference between revisions

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===Radicality slices===
===Radicality slices===
The example shown for suspected malignancy risks has parallel slices to check for radicality towards the pointy ends.<ref name=processing/> They are placed at a distance to provide similar margins as the shortest one in the short axis. However, if the shortest margin is narrower than recommended (such as less than 4 mm for a suspected squamous cell carcinoma)<ref name="BrodlandZitelli1992">{{cite journal|last1=Brodland|first1=David G.|last2=Zitelli|first2=John A.|title=Surgical margins for excision of primary cutaneous squamous cell carcinoma|journal=Journal of the American Academy of Dermatology|volume=27|issue=2|year=1992|pages=241–248|issn=01909622|doi=10.1016/0190-9622(92)70178-I}}</ref>, consider expanding the distance towards the pointy ends, either by choosing a more lateral location for the slice, or taking more slices. Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality in case the most central part contains tumor cells.
The example shown for suspected malignancy risks has parallel slices to check for radicality towards the pointy ends.<ref name=processing/> They are placed at a distance to provide similar margins as the shortest one in the short axis. However, if the shortest margin is narrower than recommended (such as less than 4 mm for a suspected squamous cell carcinoma)<ref name="BrodlandZitelli1992">{{cite journal|last1=Brodland|first1=David G.|last2=Zitelli|first2=John A.|title=Surgical margins for excision of primary cutaneous squamous cell carcinoma|journal=Journal of the American Academy of Dermatology|volume=27|issue=2|year=1992|pages=241–248|issn=01909622|doi=10.1016/0190-9622(92)70178-I}}</ref>, consider expanding the distance towards the pointy ends, either by choosing a more lateral location for the slice, or taking more slices. Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the most central part is found to have 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 pointy ends.


==Oval excisions==
==Oval excisions==

Revision as of 04:10, 1 November 2019

Author: Mikael Häggström [note 1]

Lens-shaped excisions

Also called marquise ("lens" or "boat") shape.

Table

Gross pathologic processing of skin excisions[1][note 2]
Lesion size
<4 mm 4 - 8 mm 9 - 15 mm
Benign appearance

File:Tissue selection from skin excision with lesion less than 4 mm with benign appearance.png

File:Tissue selection from skin excision with lesion 4-8 mm with benign appearance.png

File:Tissue selection from skin excision with lesion 9-15 mm with benign appearance.png

Suspected malignancy File:Tissue selection from skin excision less than 4 mm with suspected malignant lesion.png File:Tissue selection from skin excision 4-8 mm with suspected malignant lesion.png File:Tissue selection from skin excision 9-15 mm with suspected malignant lesion.png

In table above, each top image shows recommended lines for cutting out slices to be submitted for further processing. Bottom image shows which side of the slice that should be put to microtomy. Dashed lines here mean that either side could be used.

Surgical margins for suspected melanoma[2]
In situ 5 mm
≤ 2.0 mm 1 cm
> 2.0 mm 2 cm

Up to the entire specimen may be sliced and submitted if the risk of malignancy is high.[1] Otherwise the rest may be saved in case microscopy indicates further sampling.

Radicality slices

The example shown for suspected malignancy risks has parallel slices to check for radicality towards the pointy ends.[1] They are placed at a distance to provide similar margins as the shortest one in the short axis. However, if the shortest margin is narrower than recommended (such as less than 4 mm for a suspected squamous cell carcinoma)[3], consider expanding the distance towards the pointy ends, either by choosing a more lateral location for the slice, or taking more slices. Microtomy should start at the most central surface, leaving the option to perform further microtomy for radicality on the same slice in case the most central part is found to have 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 pointy ends.

Oval excisions

These can often have a parallel radicality cut along each lateral edge.[4]

Inking

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 pointy end to another, and document how the inking relates to any markings before removing them.[5]

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ The excision examples show a normal mole (upper row, benign appearance) and a superficial basal cell carcinoma (lower row, suspected malignancy).

Main page

References

  1. ↑ 1.0 1.1 1.2 There are many variants for the processing of skin excisions. These examples use aspects from the following sources: ". Ochsner J 5 (2): 22–33. 2003. PMID 22826680. PMC: 3399331. Archived from the original. . 
    - With a "standard histologic examination" that, in addition to the lesion, only includes one section from each side along the longest diameter of the specimen.
    - It also shows an example of circular coverage, with equal coverage distance in all four directions.
    - The entire specimen may be submitted if the risk of malignancy is high.
  2. ↑ Shenenberger DW (2012). "Cutaneous malignant melanoma: a primary care perspective. ". Am Fam Physician 85 (2): 161-8. PMID 22335216. Archived from the original. . 
  3. ↑ Brodland, David G.; Zitelli, John A. (1992). "Surgical margins for excision of primary cutaneous squamous cell carcinoma ". Journal of the American Academy of Dermatology 27 (2): 241–248. doi:10.1016/0190-9622(92)70178-I. ISSN 01909622. 
  4. ↑ . Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - sampling instructions, cutting principles and incision. Swedish Society of Pathology.
  5. ↑ Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.

Image sources


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