Monday, November 3, 2008 - 7:14 AM

A Reliable Frozen Section Technique for Basal Cell Carcinoma of the Head and Neck

Wisam Menesi, MD, Thomas Hayakawa, MD, and Edward W. Buchel, MD.

PURPOSE: Mohs surgery is considered the gold standard for achieving maximal tissue preservation during the excision of basal cell carcinoma in the head and neck. We evaluate the effectiveness of a surgeon directed frozen section technique that appears to offer an alternative to Mohs surgery.


MTHODS: The technique is as follows; a 1mm margin is marked beyond the visible and palpable limits of the tumor, and additional 1 mm margin is marked beyond this; the resulting margin is divided up into labeled units that will fit on a standard frozen section mounting block. With the pathologist present, the surgeon mounts each labeled unit with its surgical margin facing the cutting surface of the block. We reviewed 57 consecutive BCC’s excised over a 5 year period (2002-2006) using this technique.


RESULTS: Fifty seven BCC’s were treated. Two were recurrent tumors following radiation. Mean follow-up was 3 years. Tumors ranged in size from 0.5 x 0.4 cm to 4 x 4 cm. mean operating time was hr including the reconstruction. Histological subtypes were recorded in 21 tumors; (3) Superficial, (9) Nodular, (7) Morpheaform, (1) Sebaceous variant, (1) Sclerosing. There was a single recurrence (1.7%) identified at 13 months which was treated with minor re-excision.


CONCLUSION: Frozen section control in BCC has been notoriously frustrating and likely inaccurate due to the traditional methods of evaluating margins. Typically one or two transverse sections through the specimen are examined thus excluding the majority of the margins from evaluation. With this technique the entire circumferential margin is evaluated. It may offer a reasonable, simpler, and quicker alternative to Mohs.