A Study Of The Role Of Dermoscopy In Assisting In The Determination Of Surgical Margins For Cutaneous Squamous Cell Tumors

Section 1:The Effect of Dermoscopy in Assisting on Defining Surgical Margins of Bowen's Disease ObjectiveOur study aims to compare the efficacy for identifying the tumor boundary of Bowen's disease(BD)between visual inspection and dermoscopy,and to further explore the optimal surgical margin for Bowen's disease under the guidance of dermoscopy.MethodsA total of 19 Bowen's disease patients were enrolled for this study.For defining the he tumor boundaries of Bowen's disease,the tumor boundaries of Bowen's disease was observe with the naked eye first,and was confirmed by dermoscopy according to Bowen's disease dermoscopic patterns based on previous report.An additional 4-mm margin was marked as a surgical margin from dermocopy-detected tumor boundary.According to the four quadrant marked before the operation,pathological biopsy were performed at intervals of 2 mm for Bowen's disease.The effect of dermoscopy in surgical margin was evaluated according to the results of histopathological margin ResultsThe use of dermoscopy resulted in a larger tumor boundary in 17 of 19 patients(89.5%)than visual inspection alone.With 2mm excision margin from the dermoscopy-guided tumor boundary,excision range in 3(15.8%)of 19 patients proved to be inadequate,and surgical margins in 5(6.6 %)of 76 excision margin specimens showed histologically positive.With 4mm excision margin from the dermoscopy-guided tumor boundary,excision range in only 1(5.3%)of 19 patients proved to be inadequate,and surgical margins in 2(2.6 %)of 76 excision margin specimens showed histologically positive.ConclusionDermoscopy is superior to visual inspection for defining Bowen's disease tumor margin.A preoperative evaluation with dermoscopy could achieve a better operative management.Section 2:The Effect of Dermoscopy in Assisting on Defining Surgical Margins of Squamous Cell Carcinoma ObjectiveOur study aims to compare the efficacy for identifying the tumor boundary of Squamous Cell Carcinoma(SCC)between visual inspection and dermoscopy.To explore the value of dermoscopy combined with extended resection or MOHS micrographic surgery in the diagnosis and treatment of surgical margins in SCC.Methods A total of 57 patients with SCC were included in the study.Before the operation,the tumor boundary was observed with the naked eye first,and then confirmed again by dermoscopy based on the dermoscopic characteristics of SCC.Fifty patients underwent extended resection with an 8mm extension along the tumor boundary of the tumor defined by dermoscopy.According to the four quadrant marked before the operation,pathological biopsy were performed at intervals of 4 mm for SCC.Seven patients underwent MOHS micrographic surgery,and a 3-mm margin was designed as the surgical margin from dermoscopy-guided tumor boundary.The obtained specimens were sent to the intraoperative rapid frozen section examination in accordance with the four quadrants marked before the operation.Both surgical methods are based on the pathological results of the surgical margin to analyze their benefits.Results Comparing the results of visual inspection and dermoscopy on the tumor boundary of SCC,the results of 30(61.2%)of 49 patients were consistent,whereas the results of 19 patients(38.8%)of 49 patients were inconsistent.With 4mm excision margin from the dermoscopy-guided tumor margin,excision range in 10 patients(20%)proved to be inadequate,but only 13 surgical margins(6%)in the 200 excision margin specimens proved to be tumor-positive.There was statistically significant difference between the tumor-positive rate of specimen and tumor residual rate of patient.(P < 0.05).With 8mm excision margin from the dermoscopy-guided tumor margin,the tumor-positive rate of the specimen was only 2%,and 94% of patients achieved radical resection.In dermoscopy combined with MOHS micrographic surgery,the mean number of extended resection was 1.3 and the mean final width of extended resection was 3.6mm.With 3mm excision margin from the dermoscopy-guided tumor margin,the tumor residual rate was 14.3%.Conclusion Dermoscopy is superior to visual inspection for defining SCC margin.Dermoscopy combined with MOHS micrographic surgery can optimize the definition of SCC tumor boundaries and reduce the scope of surgical resection.