XXXX of the head and neck: treatment with Mohs surgery using inverted horizontal paraffin sections.

@entity5 @entity1 @entity241
OBJECTIVE: To describe results of treating @entity241 of the head and neck with a Mohs surgical technique in which @entity5 margins were evaluated with inverted horizontal paraffin sections to identify the margin of resection necessary to achieve @entity5 -free borders. STUDY DESIGN: Retrospective case study of nine @entity1 . METHODS: In each case, Mohs surgery using inverted horizontal frozen-section analysis was continued until @entity5 -free margins were achieved. The @entity5 -free specimens collected during this procedure were immediately reprocessed by using inverted horizontal paraffin sectioning, and the histological results of the two techniques were compared. To identify the margins of resection needed to achieve @entity5 -free margins, preoperative lesion size was compared with postoperative defect size. RESULTS: Paraffin section analysis showed persistent @entity5 in seven of the nine @entity1 in whom the frozen-section technique was used to clear the @entity5 . @entity5 -free margins were achieved in all @entity1 by using one additional excision. The @entity5 had spread extensively beyond clinical margins and required a mean minimum margin of 3.7 cm around the gross area of @entity5 (margin range, 2.5-6.0 cm). @entity1 treated by this technique showed no local, regional, or distant recurrence at follow-up performed at a mean time of 43 months postoperatively (range, 19-74 mo). CONCLUSIONS: @entity241 of the head and neck is a @entity5 that shows extensive infiltration beyond gross margins. Wide local excision with 2- to 3-cm margins results in an unacceptably high recurrence rate; larger excisional margins are necessary to remove all disease. Accurate margin identification achieved by using Mohs surgery with rush paraffin section analysis results in @entity5 removal and excellent control rates. This method should be preferred for treatment of @entity241 of the head and neck.
