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An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions

  • Head and Neck Cancers (EY Hanna, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins.

Recent Findings

The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section–guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established.

Summary

The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an “adequate” margin.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  Google Scholar 

  2. Shah JP, Gil Z. Current concepts in management of oral cancer--surgery. Oral Oncol. 2009;45(4–5):394–401. https://doi.org/10.1016/j.oraloncology.2008.05.017.

    Article  PubMed  Google Scholar 

  3. Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg. 1990;160:410–4.

    CAS  PubMed  Google Scholar 

  4. Alicandri-Ciufelli M, Bonali M, Piccinini A, Marra L, Ghidini A, Cunsolo EM, et al. Surgical margins in head and neck squamous cell carcinoma: what is ‘close’? Eur Arch Otorhinolaryngol. 2013;270(10):2603–9. https://doi.org/10.1007/s00405-012-2317-8.

    Article  PubMed  Google Scholar 

  5. Nakayama M, Holsinger C, Okamoto M, Seino Y, Miyamoto S, Takeda M, et al. Clinicopathological analyses of fifty supracricoid laryngectomized specimens: evidence base supporting minimal margins. ORL J Otorhinolaryngol Relat Spec. 2009;71:305–11.

    PubMed  Google Scholar 

  6. Ossoff RH, Sisson GA, Shapshay SM. Endoscopic management of selected early vocal cord carcinoma. Ann Otol Rhinol Laryngol. 1985;94:560–4.

    CAS  PubMed  Google Scholar 

  7. •• Wu C, Gleysteen J, Teraphongphom NT, Li Y, Rosenthal E. In-vivo optical imaging in head and neck oncology: basic principles, clinical applications and future directions. Int J Oral Sci. 2018;10(2):10. https://doi.org/10.1038/s41368-018-0011-4. This article highlights the basics and mechanism of action of most in-vivo imaging methods used.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jones AS, Hanafi ZB, Nadapalan V, et al. Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery. Br J Cancer. 1996;74:128–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. • Thomas Robbins K, Triantafyllou A, Suárez C, López F, Hunt JL, Strojan P, et al. Surgical margins in head and neck cancer: Intra- and postoperative considerations. Auris Nasus Larynx. 2019;46(1):10–7. https://doi.org/10.1016/j.anl.2018.08.011. This review article addresses the intra-operative concerns of frozen section guided margin analysis.

    Article  CAS  PubMed  Google Scholar 

  10. Jesse RH, Sugarbaker EV. Squamous cell carcinoma of the oropharynx: why we fail. Am J Surg. 1976;132:435–8.

    CAS  PubMed  Google Scholar 

  11. Shah JP, Cendon RA, Farr HW, Strong EW. Carcinoma of the oral cavity. Factors affecting treatment failure at the primary site and neck. Am J Surg. 1976;132(4):504–7.

    CAS  PubMed  Google Scholar 

  12. Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck. 2005;27:952–8.

    PubMed  Google Scholar 

  13. Richardson MS, et al. Pathologists, CoA, editor. Protocol for the examination of specimens with carcinomas of the lip and oral cavity. LipOralCavity 3.1.0.2. www.cap.org/cancerprotocols2011. Accessed 20 Jan 2020.

  14. El-Fol HA, Noman SA, Beheiri MG, Khalil AM, Kamel MM. Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma. J Craniomaxillofac Surg. 2015;43(4):475–82. https://doi.org/10.1016/j.jcms.2015.01.009.

    Article  PubMed  Google Scholar 

  15. Umstattd LA, Mills JC, Critchlow WA, Renner GJ, Zitsch RP 3rd., et al. Am J Otolaryngol. 2017;38(6):660–2. https://doi.org/10.1016/j.amjoto.2017.08.011.

    Article  PubMed  Google Scholar 

  16. Mistry RC, Qureshi SS, Kumaran C. Post-resection mucosal margin shrinkage in oral cancer: quantification and significance. J Surg Oncol. 2005;91:131–3.

    PubMed  Google Scholar 

  17. Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, et al. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol. 2005;29:167–78.

    PubMed  Google Scholar 

  18. Bryne N, Jenssen N, Boysen M. Histological grading in the deep invasive front of T1 and T2 glottic squamous cell carcinomas has high prognostic value. Virchows Arch. 1995;427:277–81.

    CAS  PubMed  Google Scholar 

  19. Li Y, Bai S, Carroll W, Dayan D, Dort JC, Heller K, et al. Validation of the risk model: high-risk classification and tumor pattern of invasion predict outcome for patients with low-stage oral cavity squamous cell carcinoma. Head Neck Pathol. 2013;7:211–23.

    CAS  PubMed  Google Scholar 

  20. Almangush A, Bello IO, Coletta RD, Mäkitie AA, Mäkinen LK, Kauppila JH, et al. For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality. Virchows Arch. 2015;467:39–46.

    PubMed  Google Scholar 

  21. Nason RW, Binahmed A, Pathak KA, Abdoh AA, Sándor GK. What is the adequate margin of surgical resection in oral cancer? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(5):625–9. https://doi.org/10.1016/j.tripleo.2008.11.013.

    Article  PubMed  Google Scholar 

  22. • Tasche KK, Buchakjian MR, Pagedar NA, Sperry SM. Definition of “close margin” in oral cancer surgery and association of margin distance with local recurrence rate. JAMA Otolaryngol Head Neck Surg. 2017;143(12):1166–72. https://doi.org/10.1001/jamaoto.2017.0548. This study analysed 432 specimens and concluded that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment.

    Article  PubMed  PubMed Central  Google Scholar 

  23. • Zanoni DK, Migliacci JC, Xu B, Katabi N, Montero PH, Ganly I, et al. A proposal to redefine close surgical margins in squamous cell carcinoma of the oral tongue. JAMA Otolaryngol Head Neck Surg. 2017;143(6):555–60. https://doi.org/10.1001/jamaoto.2016.4238. In this study of 381 patients with squamous carcinoma of the tongue, local recurrence-free survival was significantly affected only with surgical margins of less than or equal to 2.2 mm.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Amaral TMP, Freire ARS, Carvalho AL, et al. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of mouth. Oral Oncol. 2004;40:780–6.

    Google Scholar 

  25. Weijers M, Snow GB, Bezemer DP, van der Wal JE, van der Waal I. The status of the deep surgical margins in tongue and floor of mouth squamous cell carcinoma and risk of local recurrence: an analysis of 68 patients. Int J Oral Maxillofac Surg. 2004;33:146–9.

    CAS  PubMed  Google Scholar 

  26. Kademani D, Bell RB, Bagheri S, Holmgren E, Dierks E, Potter B, et al. Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral Maxillofac Surg. 2005;63:1599–605.

    PubMed  Google Scholar 

  27. Looser KG, Shah JP, Strong EW. The significance of “positive” margins in surgically resected epidermoid carcinomas. Head Neck Surg. 1978;1:107–11.

    CAS  PubMed  Google Scholar 

  28. Upile T, Fisher C, Jerjes W, El Maaytah M, Searle A, Archer D, et al. The uncertainty of the surgical margin in the treatment of head and neck cancer. Oral Oncol. 2007;43(4):321–6.

    CAS  PubMed  Google Scholar 

  29. Lubek JE, Magliocca KR. Evaluation of the bone margin in oral squamous cell carcinoma. Oral Maxillofac Surg Clin North Am. 2017;29(3):281–92. https://doi.org/10.1016/j.coms.2017.03.005.

    Article  PubMed  Google Scholar 

  30. • Singh A, Mair M, Singhvi H, Mahuvakar A, Nair D, Nair S, et al. Incidence, predictors and impact of positive bony margins in surgically treated T4 stage cancers of the oral cavity. Oral Oncol. 2019;90:8–12. https://doi.org/10.1016/j.oraloncology.2019.01.011. This study identified that the presence of lymphovascular emboli may impact the status of bony margins. Based on their results, to achieve an “adequate margin in bone” the bony cut should be taken at least 15 mm away from the clinically discernible tumor when treating advanced oral cancers.

    Article  PubMed  Google Scholar 

  31. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24–35. https://doi.org/10.1056/NEJMoa0912217.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Owadally W, Hurt C, Timmins H, Parsons E, Townsend S, Patterson J, et al. PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for human papillomavirus (HPV) positive oropharyngeal cancer. BMC Cancer. 2015;15:602. https://doi.org/10.1186/s12885-015-1598-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Li S, Ferris RL, Holsinger FC, et al. E3311 trial of transoral surgery for oropharynx cancer: implementation of a novel surgeon credentialing and quality assurance process. J Clin Oncol. 2016;34(suppl):abstr 6054.

    Google Scholar 

  34. Holsinger FC, Ferris RL. Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and clinical trials. J Clin Oncol. 2015;33(29):3285–92. https://doi.org/10.1200/JCO.2015.62.3157.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Amini A, Jasem J, Jones BL, Robin TP, McDermott JD, Bhatia S, et al. Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base. Oral Oncol. 2016;56:1–7.

    PubMed  Google Scholar 

  36. Molony P, Kharytaniuk N, Boyle S, Woods RSR, O'Leary G, Werner R, et al. Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status. Head Neck. 2017;39(8):1680–8. https://doi.org/10.1002/hed.24824.

    Article  PubMed  Google Scholar 

  37. Rosenthal DI, Pistenmaa DA, Glatstein E. A review of neoadjuvant chemotherapy for head and neck cancer: partially shrunken tumors may be both leaner and meaner. Int J Radiat Oncol Biol Phys. 1994;28(1):315–20 Review.

    CAS  PubMed  Google Scholar 

  38. Patil VM, Muttath G, Babu S, Kumar ST, Jones J, Sen S, et al. Does the use of induction chemotherapy in oral cavity cancer compromise subsequent loco-regional treatment delivery: results from a matched pair analysis. Indian J Cancer. 2015;52(4):632–6. https://doi.org/10.4103/0019-509X.178442.

    Article  CAS  PubMed  Google Scholar 

  39. Sahu P, Patil VM, Joshi A, Noronha V, Dhumal S, Kane S, et al. Neoadjuvant chemotherapy and surgical margin in technically unresectable buccal mucosa cancers. Oral Oncol. 2015;51(12):e91–2.

    PubMed  Google Scholar 

  40. Patil VM, Prabhash K, Noronha V. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol. 2014;50(10):1000–4.

    CAS  PubMed  Google Scholar 

  41. Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F, et al. Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial. J Clin Oncol. 2003;21(2):327–33.

    CAS  PubMed  Google Scholar 

  42. Zhong LP, Zhang CP, Ren GX, Guo W, William WN Jr, Sun J, et al. Randomized phase III trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma. J Clin Oncol. 2013;31:744–51.

    CAS  PubMed  Google Scholar 

  43. Marta GN, Riera R, Bossi P, Zhong LP, Licitra L, Macedo CR, et al. Induction chemotherapy prior to surgery with or without postoperative radiotherapy for oral cavity cancer patients: systematic review and meta-analysis. Eur J Cancer. 2015;51(17):2596–603. https://doi.org/10.1016/j.ejca.2015.08.007 Review.

    Article  PubMed  Google Scholar 

  44. Grant DG, Bradley PT, Parmar A, Toll EC, Baldwin DL, Porter GC, et al. Implications of positive margins or incomplete excision in laryngeal cancer treated by transoral laser microsurgery: how we do it. Clin Otolaryngol. 2009;34:485–9.

    CAS  PubMed  Google Scholar 

  45. Preuss SF, Cramer K, Drebber U, Klussmann JP, Eckel HE, Guntinas-Lichius O. Second-look microlaryngoscopy to detect residual carcinoma in patients after laser surgery for T1 and T2 laryngeal cancer. Acta Otolaryngol. 2009;129:881–5.

    PubMed  Google Scholar 

  46. Brøndbo K, Fridrich K, Boysen M. Laser surgery of T1a glottic carcinomas; significance of resection margins. Eur Arch Otorhinolaryngol. 2007;264:627–30.

    PubMed  Google Scholar 

  47. Hendriksma M, Montagne MW, Langeveld TPM, Veselic M, van Benthem PPG, Sjögren EV. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO(2) laser microsurgery, on local control. Eur Arch Otorhinolaryngol. 2018;275(9):2333–40. https://doi.org/10.1007/s00405-018-5070-9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Peretti G, Piazza C, Cocco D, de Benedetto L, del Bon F, Redaelli de Zinis LO, et al. Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck. 2010;32:977–83.

    PubMed  Google Scholar 

  49. Bradford CR, Wolf GT, Fisher SG, McClatchey KD. Prognostic importance of surgical margins in advanced laryngeal squamous carcinoma. Head Neck. 1996;18(1):11–6.

    CAS  PubMed  Google Scholar 

  50. Ho CM. Submucosal tumor extension in hypopharyngeal cancer. Arch Otolaryngol Head Neck Surg. 1997;123:959–65. https://doi.org/10.1001/archotol.1997.01900090073010.

    Article  CAS  PubMed  Google Scholar 

  51. Ho CM, Ng WF, Lam KH, Wei WI, Yuen AP. Radial clearance in resection of hypopharyngeal cancer: an independent prognostic factor. Head Neck. 2002;24:181–90. https://doi.org/10.1002/hed.10002.

    Article  PubMed  Google Scholar 

  52. Nahhas AF, Scarbrough CA, Trotter S. A review of the global guidelines on surgical margins for nonmelanoma skin cancers. J Clin Aesthet Dermatol. 2017;10(4):37–46 Review.

    PubMed  PubMed Central  Google Scholar 

  53. Du E, Ow TJ, Lo YT, Gersten A, Schiff BA, Tassler AB, et al. Refining the utility and role of frozen section in head and neck squamous cell carcinoma resection. Laryngoscope. 2016;126(8):1768–75. https://doi.org/10.1002/lary.25899.

    Article  PubMed  Google Scholar 

  54. Layfield Eleanor M, Schmidt Robert L, Magda E, Lester J. Layfield frozen section evaluation of margin status in primary squamous cell carcinomas of the head and neck: a correlation study of frozen section and final diagnoses. Head Neck Pathol. 2018;12:175–80.

    CAS  PubMed  Google Scholar 

  55. Kerawala CJ, Ong TK. Relocating the site of frozen sections—is there room for improvement? Head Neck. 2001;23:230–2.

    CAS  PubMed  Google Scholar 

  56. •• Bulbul MG, Tarabichi O, Sethi RK, Parikh AS, Varvares MA. Does clearance of positive margins improve local control in oral cavity cancer? A meta-analysis. Otolaryngol Head Neck Surg. 2019;161(2):235–44. https://doi.org/10.1177/0194599819839006. This study has found that margin revision of initially positive margins to “clear” based on frozen section guidance does not equate to an initially negative margin and does not significantly improve local control. These findings call into question the effectiveness of the current methodology of intraoperative frozen section in oral cancers.

    Article  PubMed  Google Scholar 

  57. Varvares MA, Poti S, Kenyon B, Christopher K, Walker RJ. Surgical margins and primary site resection in achieving local control in oral cancer resections. Laryngoscope. 2015;125:2298–307.

    PubMed  Google Scholar 

  58. Mair M, Nair D, Nair S, Dutta S, Garg A, Malik A, et al. Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(5):544–9. https://doi.org/10.1016/j.oooo.2016.11.018.

    Article  PubMed  Google Scholar 

  59. Chaturvedi P, Datta S, Nair S, Nair D, Pawar P, Vaishampayan S, et al. Gross examination by the surgeon as an alternative to frozen section for assessment of adequacy of surgical margin in head and neck squamous cell carcinoma. Head Neck. 2014;36(4):557–63. https://doi.org/10.1002/hed.23313.

    Article  PubMed  Google Scholar 

  60. DiNardo LJ, Lin J, Karageorge LS, Powers CN. Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery. Laryngoscope. 2000;110(October (10 Pt 1)):1773–6.

    CAS  PubMed  Google Scholar 

  61. • Datta S, Mishra A, Chaturvedi P, Bal M, Nair D, More Y, et al. Frozen section is not cost beneficial for the assessment of margins in oral cancer. Indian J Cancer. 2019;56(1):19–23. https://doi.org/10.4103/ijc.IJC_41_18. This study highlights the poor cost-benefit ratio of using frozen section assessment of margins. They also conclude that meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.

    Article  PubMed  Google Scholar 

  62. Bilodeau EA, Chiosea S. Oral squamous cell carcinoma with mandibular bone invasion: intraoperative evaluation of bone margins by routine frozen section. Head Neck Pathol. 2011;5(3):216–20. https://doi.org/10.1007/s12105-011-0264-0.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Forrest LA, Schuller DE, Lucas JG, Sullivan MJ. Rapid analysis of mandibular margins. Laryngoscope. 1995;105:475–7.

    CAS  PubMed  Google Scholar 

  64. Mahmood S, Conway DI, Ramesar K. Use of intra-operative cytological assessment of mandibular marrow scrapings to predict resection margin status in patients with squamous cell carcinoma. J Oral Maxillofac Surg. 2001;59:1138–41.

    CAS  PubMed  Google Scholar 

  65. Oxford LE, Ducic Y. Intraoperative evaluation of cortical bony margins with frozen-section analysis. Otolaryngol Head Neck Surg. 2006;134:138–41.

    PubMed  Google Scholar 

  66. Wysluch A, Stricker I, Holzle F, Wolff K-D, Maurer P. Intraoperative evaluation of bony margins with frozen-section analysis and trephine drill extraction technique: a preliminary study. Head Neck. 2010;32:1473–8.

    PubMed  Google Scholar 

  67. Weisberger EC, Hilburn M, Johnson B, Nguyen C. Intraoperative microwave processing of bone margins during resection of head and neck cancer. Arch Otolaryngol Head Neck Surg. 2001;127:790–3.

    CAS  PubMed  Google Scholar 

  68. Jerjes W, Swinson B, Johnson KS, Thomas GJ, Hopper C. Assessment of bony resection margins in oral cancer using elastic scattering spectroscopy: a study on archival material. Arch Oral Biol. 2005;50:361–6.

    CAS  PubMed  Google Scholar 

  69. DaCosta RS, Andersson H, Wilson BC. Molecular fluorescence excitation-emission matrices relevant to tissue spectroscopy. Photochem Photobiol. 2003;78:384–92.

    CAS  PubMed  Google Scholar 

  70. Keereweer S, Sterenborg HJ, Kerrebijn JD, Van Driel PB, Baatenburg de Jong RJ, Löwik CW. Image-guided surgery in head and neck cancer: current practice and future directions of optical imaging. Head Neck. 2012;34(1):120–6. https://doi.org/10.1002/hed.21625.

    Article  CAS  PubMed  Google Scholar 

  71. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. 2000;100:57–70.

    CAS  PubMed  Google Scholar 

  72. Poh CF, Anderson DW, Durham JS, Chen J, Berean KW, MacAulay CE, et al. Fluorescence visualization-guided surgery for early-stage oral cancer. JAMA Otolaryngol Head Neck Surg. 2016;142(3):209–16. https://doi.org/10.1001/jamaoto.2015.3211.

    Article  PubMed  Google Scholar 

  73. Barroso EM, Smits RW, Bakker Schut TC, ten Hove I, Hardillo JA, Wolvius EB, et al. Discrimination between oral cancer and healthy tissue based on water content determined by Raman spectroscopy. Anal Chem. 2015;87:2419–26.

    CAS  PubMed  Google Scholar 

  74. Cals FL, Bakker Schut TC, Hardillo JA, Baatenburg de Jong RJ, Cals FL, Bakker Schut TC, et al. Investigation of the potential of Raman spectroscopy for oral cancer detection in surgical margins. Lab Investig. 2015;95:1186–96.

    CAS  PubMed  Google Scholar 

  75. Zhang J, Rector J, Lin JQ, Young JH, Sans M, Katta N, et al. Nondestructive tissue analysis for ex vivo and in vivo cancer diagnosis using a handheld mass spectrometry system. Sci Transl Med. 2017;9(406):eaan3968.

    PubMed  PubMed Central  Google Scholar 

  76. Cikojevı’c D, Gluncı’c I, Pesutı’c-Pisac V. Comparison of contact endoscopy and frozen section histopathology in the intra-operative diagnosis of laryngeal pathology. J Laryngol Otol. 2008;122:836–9.

    Google Scholar 

  77. Dedivitis RA, Pfuetzenreiter EG Jr, Guimarães AV. Contact endoscopy of the larynx as an auxiliary method to the surgical margins in frontolateral laryngectomy. Acta Otorhinolaryngol Ital. 2009;29:16–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Miles BA, Patsias A, Quang T, Polydorides AD, Richards-Kortum R, Sikora AG. Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma. Laryngoscope. 2015;125(October (10)):2308–16.

    PubMed  Google Scholar 

  79. Peterson G, Zanoni DK, Ardigo M, Migliacci JC, Patel SG, Rajadhyaksha M. Feasibility of a video-mosaicking approach to extend the field-of-view for reflectance confocal microscopy in the oral cavity in vivo. Lasers Surg Med. 2019. https://doi.org/10.1002/lsm.23090.

  80. Plaat BEC, Zwakenberg MA, van Zwol JG, Wedman J, van der Laan BFAM, Halmos GB, et al. Narrow-band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome. Head Neck. 2017;39(July (7)):1343–8.

    PubMed  Google Scholar 

  81. Garofolo S, Piazza C, Del Bon F, Mangili S, Guastini L, Mora F, et al. Intraoperative narrow band imaging better delineates superficial resection margins during transoral laser microsurgery for early glottic cancer. Ann Otol Rhinol Laryngol. 2015;124(April (4)):294–8.

    PubMed  Google Scholar 

  82. Hamdoon Z, Jerjes W, McKenzie G, Jay A, Hopper C. Optical coherence tomography in the assessment of oral squamous cell carcinoma resection margins. Photodiagn Photodyn Ther. 2016;13(March):211–7.

    Google Scholar 

  83. Baek CH, Son YI, Jeong HS, Chung MK, Park KN, Ko YH, et al. Intraoral sonography-assisted resection of T1–2 tongue cancer for adequate deep resection. Otolaryngol Head Neck Surg. 2008;139(December (6)):805–10.

    PubMed  Google Scholar 

  84. McMahon JD, Devine JC, Hetherington J, et al. Involved surgical margins in oral and oropharyngeal carcinoma—an anatomical problem? Br J Oral Maxillofac Surg. 2011;49:172–5.

    PubMed  Google Scholar 

  85. Rosenthal EL, Warram JM, de Boer E, Chung TK, Korb ML, Brandwein-Gensler M, et al. Safety and tumor specificity of cetuximab- IRDye800 for surgical navigation in head and neck cancer. Clin Cancer Res. 2015;21(August (16)):3658–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Woolgar JA, Triantafyllou A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol. 2005;41:1034–43.

    PubMed  Google Scholar 

  87. Hinni ML, Ferlito A, Brandwein-Gensler MS, Takes RP, Silver CE, Westra WH, et al. Surgical margins in head and neck cancer: a contemporary review. Head Neck. 2013;35(9):1362–70. https://doi.org/10.1002/hed.23110.

    Article  PubMed  Google Scholar 

  88. Amit M, Na’ara S, Leider-Trejo L, Akrish S, Cohen JT, Billan S, et al. Improving the rate of negative margins after surgery for oral cavity squamous cell carcinoma: a prospective randomized controlled study. Head Neck. 2016;38(April (Suppl 1)):E1803–9.

    PubMed  Google Scholar 

  89. Sigston E, de Mones E, Babin E, Hans S, Hartl DM, Clement P, et al. Early-stage glottic cancer: oncological results and margins in laser cordectomy. Arch Otolaryngol Head Neck Surg. 2006;132:147–52.

    PubMed  Google Scholar 

  90. Hartl DM, de Mone’s E, Hans S, et al. Treatment of early-stage glottic cancer by transoral laser resection. Ann Otol Rhinol Laryngol. 2007;116:832–6.

    PubMed  Google Scholar 

  91. Homer JJ, Fardy MJ. Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S68–70 Erratum in: J Laryngol Otol. 2016 Aug;130(8):792.

    CAS  PubMed  PubMed Central  Google Scholar 

  92. Hinni ML, Zarka MA, Hoxworth JM. Margin mapping in transoral surgery for head and neck cancer. Laryngoscope. 2013;123:1190–8.

    PubMed  Google Scholar 

  93. Broders AC. Squamous-cell epithelioma of the lip: a study of five hundred and thirty-seven cases. JAMA. 1920;74:656–64.

    Google Scholar 

  94. Brandwein-Gensler M, Smith RV, Wang B, Penner C, Theilken A, Broughel D, et al. Validation of the histologic risk model in a new cohort of patients with head and neck squamous cell carcinoma. Am J Surg Pathol. 2010;34:676–88.

    PubMed  Google Scholar 

  95. Mohan M, Jagannathan N. Oral field cancerization: an update on current concepts. Oncol Rev. 2014;8(1):244. https://doi.org/10.4081/oncol.2014.244.eCollection2014Mar17 Review.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Mao L, Clark D. Molecular margin of surgical resections--where do we go from here? Cancer. 2015;121(12):1914–6. https://doi.org/10.1002/cncr.29299.

    Article  PubMed  Google Scholar 

  97. Hayashi M, Wu G, Roh JL, Chang X, Li X, Ahn J, et al. Correlation of gene methylation in surgical margin imprints with locoregional recurrence in head and neck squamous cell carcinoma. Cancer. 2015;121(12):1957–65. https://doi.org/10.1002/cncr.29303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Head and Neck Oncology Department, Tata Memorial Hospital and HBNI, Mumbai, India

    Arjun Singh, Burhanuddin Qayyumi & Pankaj Chaturvedi

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  1. Arjun Singh
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  2. Burhanuddin Qayyumi
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  3. Pankaj Chaturvedi
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Correspondence to Pankaj Chaturvedi.

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Singh, A., Qayyumi, B. & Chaturvedi, P. An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 22, 82 (2020). https://doi.org/10.1007/s11912-020-00942-7

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