3D Frozen Section Histology - A Technique for Perioperative Complete Evaluation of Surgical Margins in Non-Melanoma Skin Cancer

Background: Basal Cell Carcinoma (BCC) is a highly prevalent skin malignancy often requiring surgical excision. Tumors are frequently located on facial subunits where tissue sparing is a priority. Traditional treatment with excision and bread loaf histology, without frozen sections, samples the surgical margins sparingly, leaving a risk of false negative resection margins. 3D histology is an array of methods aimed at ensuring examination of the entire surgical margin. We present a modified 3D method for BCC on high-risk facial localizations, allowing complete margin control perioperatively, which is practicable in a standard hospital setting without requiring extensive training of personnel.

Cases: Three cases are presented, illustrating the method.

Methods: The tumor borders are defined and marked. A double-bladed scalpel is used for excision of a circular surgical margin around the entire tumor, and a single blade is used for excision of the tumor. Both are dyed and cryostat sectioned in the pathology lab and examined by the histopathologist.

Conclusions: 3D histology techniques have shown high rates of sensitivity, reducing the occurrence of false negative margins and ultimately recurrence rates of BCC, thus reducing the morbidity for patients. Most carcinomas are completely excised in one surgical intervention with this method. The method uses vertical incisions, creating a surgical bed optimized for reconstructive surgery. This 3D histology technique ensures microscopical examination of the entire surgical margin, ensuring the smallest possible defect with radically excised tumor, and is feasible in a standard hospital setting.

Keywords: 3D histology; Basal cell carcinoma; Frozen sections; Microscopically controlled surgery