Achieving clear margins during surgical resection in oral cavity squamous cell carcinoma (OCSCC) is thought to reduce local recurrence (LR) and improve prognosis; however, what constitutes a clear, close, or involved margin is inconsistent in the literature and in practice. Most commonly, a margin of less than 5mm has been considered close, however, this determination appears to have been arbitrary and has persisted despite a lack of supporting evidence. A review of articles that report outcomes specifically for patients with close margins demonstrates a broad range of local recurrence rates, from 6% to 74%, but these have generally placed patients with margins of less than 5 mm into one group and have not considered individual margin distances. In this study, authors have sought to gain clarity on what should be considered a clinically significant close margin. Local recurrence (LR) rate for microscopic positive margins was 44%; for margins less than 1mm, 28%; for 1mm, 17%; for 2mm, 13%; for 3mm, 13%; for 4mm, 14%; and for 5mm or greater, 11%. This retrospective analysis of a series of patients with OCSCC treated with surgery demonstrates that the risk of LR increases rapidly with less than a 1mm distance from the cut tissue edge and such patients may benefit from additional treatment.
What should be considered a ‘close’ margin in oral cavity squamous cell carcinoma?
Reviewed by Shabbir Akhtar
Definition of “close margin” in oral cancer surgery and association of margin distance with local recurrence rate.
CONTRIBUTOR
Shabbir Akhtar
Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.
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