- Place sutures around the tongue lesion at 1 cm from the edge to get a 1 cm margin.
- Control the edges with the strings, like a puppeteer, as you do the mucosal incisions.
- Consider using a Colorado needle for the Bovie, and a harmonic scalpel. With these, he said, you get little to no bleeding and little char, making the sample easier for the pathologist to evaluate. “There’s not a lot of associated burn.”
- Aim for a specimen shaped “like a canoe”—deeper in the middle and more narrow and more shallow at the ends. This gives a well-defined specimen without taking extra tongue, he said.
- Mark the specimen with string. Dr. Deschler leaves a shorter string on the superior edge of the specimen—both “shorter” and “superior” start with “S”—so there’s no confusion once the specimen is at pathology.
There were different views on margins in these cases. Panelist Nilesh Vasan, MD, associate professor of otolaryngology-head and neck surgery at Oklahoma Health Sciences Center in Oklahoma City, said he likes to use the sutures as well, but prefers 1.5-cm margins—a study he worked on showed that this size margin resulted in a clear margin in 96% of cases.
In these cases, he acknowledged, sometimes a flap is needed to reconstruct. “We do have wide margins but oftentimes, depending on what the status of the neck is, they may not need any further adjuvant treatment,” he said. “I’ve never really worried about the defect. My job is to get that cancer out with clear margins.”
Dr. Deschler said he would be worried about “bringing in uninvolved tongue at either edge to get it around the back” and that he can often have patients leave with no perineural and no perivascular involvement and clear margins with more minimal morbidity.