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 Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

s, especially

skin cancer Skin cancers are cancers that arise from the Human skin, skin. They are due to the development of abnormal cells (biology), cells that have the ability to invade or metastasis, spread to other parts of the body. It occurs when skin cells grow ...

s. There are two forms of CCPDMA surgery:

Mohs surgery Mohs surgery, developed in 1938 by 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, the ...

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

pathology Pathology is the study of disease. 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 the context of modern medical treatme ...

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 ...

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 resu ...

error rate. Bread loafing extrapolates the margin exam of a few representative slides to the entire

surgical margin A resection margin or surgical margin is the edge or "margin" of apparently non-tumorous tissue around a tumor that has been surgically removed, called "Resection (surgery), resected", in surgical oncology. The resection is an attempt to remove ...

. 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 medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

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 is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye (uveal melanoma). In very rare case ...

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