Complete circumferential peripheral and deep margin assessment (CCPDMA) is the preferred method for the removal of certain

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

s, especially

skin cancer Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC) ...

s. There are two forms of CCPDMA surgery:

Mohs surgery 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, ...

and surgical excision coupled with margin assessment. Other examples of CCPDMA are found in classical

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

textbooks as techniques of cutting surgical specimens to allow the examination of the inferior and lateral margins of typically elliptical surgical specimens. __TOC__

Comparison to alternatives

CCPDMA is superior to standard

bread loafing Bread loafing is a common method of processing surgical specimens for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then t ...

due to very low

false negative A false positive is an error in binary classification in which a test result incorrectly indicates the presence of a condition (such as a disease when the disease is not present), while a false negative is the opposite error, where the test resul ...

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 In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

to remove only a very small surgical margin. As the CCPDMA surgery is frequently performed using

frozen section The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryosection. The microtome device tha ...

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.Kimyai-Asadi A, et al. Dermatol Surg. 2007 Dec;33(12):1434-9; discussion 1439-41. Margin involvement after the excision of

melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...

in situ: the need for complete en face examination of the surgical margins. 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.

Additional images

References

{{reflist Dermatologic procedures