Gross processing of skin excisions

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.

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.

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

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 seen in the sample. 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.

Notes

↑ 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.
↑ The excision examples show a normal mole (upper row, benign appearance) and a superficial basal cell carcinoma (lower row, suspected malignancy).

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References

↑ ^1.0 ^1.1 ^1.2
There are many variants for the processing of skin excisions. These examples use aspects from the following sources:
- . Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - sampling instructions, cutting principles and incision. Swedish Society of Pathology.
  - For number of slices and coverage of lesions, depending on size.
- Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  - For slices towards the tips to determine radicality, which can be parallel to the slices through the lesions (shown), or as longitudinal slices that go through each tip.
- . Dermatopathology Grossing Guidelines. University of California, Los Angeles. Retrieved on 2019-10-23.
  - For microtomy of the most central side at the lesion
- "The principles of mohs micrographic surgery for cutaneous neoplasia
". 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.
↑ Shenenberger DW (2012). "Cutaneous malignant melanoma: a primary care perspective. ". Am Fam Physician 85 (2): 161-8. PMID 22335216. Archived from the original. .
↑ 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.

Image sources

[contributors-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.

[3] The excision examples show a normal mole (upper row, benign appearance) and a superficial basal cell carcinoma (lower row, suspected malignancy).

[processing-2] 1.0 ^1.1 ^1.2 There are many variants for the processing of skin excisions. These examples use aspects from the following sources:
. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - sampling instructions, cutting principles and incision. Swedish Society of Pathology.
- For number of slices and coverage of lesions, depending on size.

Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- For slices towards the tips to determine radicality, which can be parallel to the slices through the lesions (shown), or as longitudinal slices that go through each tip.

. Dermatopathology Grossing Guidelines. University of California, Los Angeles. Retrieved on 2019-10-23.
- For microtomy of the most central side at the lesion

"The principles of mohs micrographic surgery for cutaneous neoplasia
". 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.

[4] . Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - sampling instructions, cutting principles and incision. Swedish Society of Pathology.
- For number of slices and coverage of lesions, depending on size.

[5] Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- For slices towards the tips to determine radicality, which can be parallel to the slices through the lesions (shown), or as longitudinal slices that go through each tip.

[6] . Dermatopathology Grossing Guidelines. University of California, Los Angeles. Retrieved on 2019-10-23.
- For microtomy of the most central side at the lesion

[7] "The principles of mohs micrographic surgery for cutaneous neoplasia

[pmid22335216-4] Shenenberger DW (2012). "Cutaneous malignant melanoma: a primary care perspective. ". Am Fam Physician 85 (2): 161-8. PMID 22335216. Archived from the original. .

[BrodlandZitelli1992-5] 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.

[note 1]

[1]

[note 2]

[2]

[3]

Gross processing of skin excisions

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Gross processing of skin excisions

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