Complete circumferential peripheral and deep margin assessment
Résumé
Complete circumferential peripheral and deep margin assessment (CCPDMA) is the preferred method for the removal of certain cancers, especially skin cancers.
There are two forms of CCPDMA surgery: Mohs surgery and surgical excision coupled with margin assessment. Other examples of CCPDMA are found in classical pathology textbooks as techniques of cutting surgical specimens to allow the examination of the inferior and lateral margins of typically elliptical surgical specimens.
TOC
CCPDMA is superior to standard bread loafing due to very low false negative error rate. Bread loafing extrapolates the margin exam of a few representative slides to the entire surgical margin. CCPDMA allows for the complete examination of the surgical margin without statistical extrapolation and assumptions.
The first advantage of CCPDMA method is that it allows for the complete examination of the entire surgical margin of the specimen. The second advantage of CCPDMA is allowing the surgeon to remove only a very small surgical margin. As the CCPDMA surgery is frequently performed using frozen section pathology, immediate reporting of positive surgical margin is made, and the tumor can be completely removed in the same day. Traditional pathology processing is called "bread loafing", and only allows for the partial examination of the surgical margin. Some surgeons send the specimen out for processing, and the result of the surgical margin assessment may not be made until days later.
CCPDMA is subject to the basic principles of histology sectioning. From a physical standpoint, the true margin is never assessed because a thin face margin has to be cut through in order to make the slide for examination. Therefore, a true and complete assessment of all margins is never achieved. Serial sectioning allows CCPDMA approaches near-complete evaluation of the surgical margin and may be performed by pathologists, dermatologists, and surgeons.
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Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat both common and rare types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination dictates the decision for additional tissue removal. Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (complete circumferential peripheral and deep margin assessment - CCPDMA) using frozen section histology.
vignette|Les organes internes sont rarement touchés, mais cela peut exceptionnellement se produire, comme ici : gros mélanome du cerveau (Autopsie, archives militaires médicales américaines) Le mélanome est un cancer de la peau ou des muqueuses, développé aux dépens des mélanocytes (tumeur mélanocytaire). Son siège initial est la peau dans l'immense majorité des cas. Il existe toutefois des mélanomes de l'œil (mélanome choroïdien), des muqueuses (bouche, canal anal, vagin), et plus rarement encore des organes internes.
Les cancers de la peau sont des tumeurs malignes d'histologie variée, développées aux dépens des cellules de la peau. On distingue principalement : les épithéliomes, dérivant du tissu épithélial, eux-mêmes composés de deux grands groupes de carcinomes : le carcinome basocellulaire et le carcinome spinocellulaire ; les mélanomes, développés à partir des cellules næviques, qui peuvent résulter de la transformation d'un nævus ou se développer de novo ; et les sarcomes, développés à partir du tissu conjonctif.
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