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Abstract

Background

Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions.

Objective

To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size.

Materials and Methods

One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary.

Results

Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas.

Conclusion

Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.

Keywords

curettage squamous cell carcinoma basal cell carcinoma nonmelanoma skin cancer Mohs micrographic surgery excision

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References

Ratner

Skouge

Surgical management of local disease. In: Miller

Maloney

eds. Cutaneous Oncology: Pathophysiology, Diagnosis, and Management. MA: Wiley; 1998:664–671.

Mikhai

. Practical pointers. In: Mikhail

, ed. Mohs Micrographic Surgery. Philadelphia: W.B. Saunders; 1991:343–354.

Lutz

ME.

Surgical Pearl: curettage before cutaneous surgery to identify an unidentifiable biopsy site. J Am Acad Dermatol. 2002;46(4):591-593.

Arpey

CJ.

Is curettage useful prior to performing Mohs or excisional surgery? When and how do you use it?

Dermatol Surg. 2000;26(2):165; discussion 165-166.

Huang

Boyce

Northington

Desmond

Soong

S-J.

Randomized, controlled surgical trial of preoperative tumor curettage of basal cell carcinoma in Mohs micrographic surgery. J Am Acad Dermatol. 2004;51(4):585-591.

Jih

Friedman

Goldberg

Kimyai-Asadi

Curettage prior to Mohs’ micrographic surgery for previously biopsied nonmelanoma skin cancers: what are we curetting? Retrospective, prospective, and comparative study. Dermatol Surg. 2005;31(1):10–15.

Ratner

Bagiella

The efficacy of curettage in delineating margins of basal cell carcinoma before Mohs micrographic surgery. Dermatol Surg. 2003;29(9):899-903.

Chung

Bernardo

Jiang

SB.

Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins. Dermatol Surg. 2005;31(9 Pt 1):1094-1099; discussion 1100.

Bouzari

Olbricht

Histologic pitfalls in the Mohs technique. Dermatol Clin. 2011;29(2):261-272, ix.

10.

Adam

JE.

The technic of curettage surgery. J Am Acad Dermatol. 1986;15(4 Pt 1):697-702.

11.

Sheridan

Dawber

RP.

Curettage, electrosurgery and skin cancer. Australas J Dermatol. 2000;41(1):19-30.

12.

Miller

SJ.

Biology of basal cell carcinoma (Part I). J Am Acad Dermatol. 1991;24(1):1-13.

13.

Reymann

15 years’ experience with treatment of basal cell carcinomas of the skin with curettage. Acta Derm Venereol Suppl (Stockh). 1985;120:56-59.

14.

McDaniel

WE.

Therapy for basal cell epitheliomas by curettage only. Further study. Arch Dermatol. 1983;119(11):901-913.

15.

Werlinger

Upton

Moore

AY.

Recurrence rates of primary nonmelanoma skin cancers treated by surgical excision compared to electrodesiccation-curettage in a private dermatological practice. Dermatol Surg. 2002;28(12):1138-1142; discussion 1142.

16.

Goldman

The current status of curettage and electrodesiccation. Dermatol Clin. 2002;20(3):569–578, ix.

17.

Freeman

Knox

Heaton

CL.

The treatment of skin cancer: a statistical study of 1,341 skin tumors comparing results obtained with irradiation, surgery, and curettage followed by electrodessication. Cancer. 1964;17:535-538.

18.

Silverman

Kopf

Grin

Bart

Levenstein

MJ.

Recurrence rates of treated basal cell carcinomas. Part 2: curettage-electrodesiccation. J Dermatol Surg Oncol. 1991;17(9):720–726.

19.

Kopf

Bart

Schrager

Lazar

Popkin

GL.

Curettage-electrodesiccation treatment of basal cell carcinomas. Arch Dermatol. 1977;113(4):439-443.

20.

Nordin

Stenquist

Five-year results of curettage-cryosurgery for 100 consecutive auricular non-melanoma skin cancers. J Laryngol Otol. 2002;116(11):893-898.

21.

Chiller

Passaro

McCalmont

Vin-Christian

Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer. Arch Dermatol. 2000;136(11):1327-1332.

22.

Johnson

Tromovitch

Swanson

NA.

Combined curettage and excision: a treatment method for primary basal cell carcinoma. J Am Acad Dermatol. 1991;24(4):613-617.

23.

Lee

Ratner

Economic impact of preoperative curettage before Mohs micrographic surgery for basal cell carcinoma. Dermatol Surg. 2006;32(7):916-922; discussion 922-923.

24.

Robinson

Anatomy for procedural dermatology. In: Robinson

Hanke

Sengelmann

eds. Surgery of the Skin. 3rd ed. Philadelphia: Elsevier; 2014.

Presurgical Curettage Improves Accuracy for Nonmelanoma Skin Cancer Excision

Abstract

Background

Objective

Materials and Methods

Results

Conclusion

Keywords

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References