Abstract
We introduced the double-bladed scalpel as a novel, simple method for complete histological margin control that improves the pathodiagnostic reliability of conventional intraoperative histological evaluation for 40 highrisk non-melanoma skin cancer patients in Hokkaido University. To clear a tumor, 22.5% of all the cases required two stages. The total mean surgical margins were 5.0±2.8 mm in basal cell carcinomas, 4.9±2.1 mm in squamous cell carcinomas, 5.7±2.3 mm in primary mucinous carcinomas, 7±4.2 mm in Merkel cell carcinomas, and 7 mm in one case of sebaceous carcinoma. The results also showed statistically significant correlations between anatomical distribution of the lesions (nose) and the number of additional stages required to clear a tumor in basal cell carcinomas. A comparison of the total mean surgical margins showed significant differences in histologic grading between aggressive and nonaggressive groups. Complete histological margin control using a double-bladed scalpel could be easily applied to standard intraoperative frozen section evaluation in many institutions where Mohs micrographic surgery is difficult to perform. It is far less time-consuming and can be easily used by surgeons with existing systems, even in Japan.
