Surgical margin
Encyclopedia
Surgical margin, also known as tumor free margin, free margin, normal skin margin, and normal tissue margin, usually refers to the visible normal tissue or skin margin that is removed with the surgical excision
of a tumor
, growth, or malignancy.
with the naked eye. Surgical margin as read in a pathology
report define the histological measurement of normal or unaffected tissue surrounding the visible tumor
under a microscope
on a glass mounted histology section. A "narrow" surgical margin implies that the tumor exists very close to the surgical margin, and a "wide" surgical margin implies the tumor exists far from the cut edge or the surgical margin. Narrow surgical margin using the bread loafing
technique suggests that residual cancer might be left due to false negative error. A surgeon often will perform a second surgery if a narrow surgical margin is noted on a pathology report.
technique of histology (also known as POMA - a term used by the NCCN). The higher is the false negative error, the higher is the recurrence rate of a cancer or tumor at the surgical margin. This is due to the misreading of a pathology specimen as being clear of residual tumor, when there is actually residual tumor left where the specimen was not cut and mounted on the histology slide. The "false negative error" is very low in the ccpdma
method of histology processing, and can be very high in the bread loafing
(POMA) method of histology processing. In the bread loafing method of processing, one will note a high false negative error rate with narrow surgical margin; and one will note a low false negative error with a wide surgical margin Surgical margin has a much less significant effect on the false negative error rate of CCPDMA
methods, allowing the surgeon to routinely use very narrow surgical margins (1 to 2 mm for non-melanoma skin cancer).
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
of a tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
, growth, or malignancy.
Definition
Surgical margin in a surgery reports define the visible margin or free edge of "normal" tissue seen by the surgeonSurgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
with the naked eye. Surgical margin as read in a pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
report define the histological measurement of normal or unaffected tissue surrounding the visible tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
under a microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
on a glass mounted histology section. A "narrow" surgical margin implies that the tumor exists very close to the surgical margin, and a "wide" surgical margin implies the tumor exists far from the cut edge or the surgical margin. Narrow surgical margin using the bread loafing
Bread loafing
Bread loafing is a common method of processing surgical specimen for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then thinly sliced with a microtome or a cryostat...
technique suggests that residual cancer might be left due to false negative error. A surgeon often will perform a second surgery if a narrow surgical margin is noted on a pathology report.
Associated errors and recurrence rate
This determination is made with the full understanding of "false negative error" intrinsic in the bread loafingBread loafing
Bread loafing is a common method of processing surgical specimen for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then thinly sliced with a microtome or a cryostat...
technique of histology (also known as POMA - a term used by the NCCN). The higher is the false negative error, the higher is the recurrence rate of a cancer or tumor at the surgical margin. This is due to the misreading of a pathology specimen as being clear of residual tumor, when there is actually residual tumor left where the specimen was not cut and mounted on the histology slide. The "false negative error" is very low in the ccpdma
CCPDMA
CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancers, especially skin cancers.A classical example of CCPDMA is Mohs surgery...
method of histology processing, and can be very high in the bread loafing
Bread loafing
Bread loafing is a common method of processing surgical specimen for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then thinly sliced with a microtome or a cryostat...
(POMA) method of histology processing. In the bread loafing method of processing, one will note a high false negative error rate with narrow surgical margin; and one will note a low false negative error with a wide surgical margin Surgical margin has a much less significant effect on the false negative error rate of CCPDMA
CCPDMA
CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancers, especially skin cancers.A classical example of CCPDMA is Mohs surgery...
methods, allowing the surgeon to routinely use very narrow surgical margins (1 to 2 mm for non-melanoma skin cancer).