Margin control in oral squamous cell carcinoma: A survey of contemporary practice in India

Background Determining margin status is the key in management of oral squamous cell carcinoma, indicating risk of local recurrence and guiding the use of adjuvant therapy. Frozen sections are commonly employed intraoperatively to assess the adequacy of resections. There is however no standard approach as to how frozen sections are used. A practice based survey was carried out in an attempt to establish consensus between surgeons and pathologists with regards to margin sampling and acceptable surgical margins. Methods A questionnaire consisting of twelve questions was sent to surgical oncologists in various head and neck cancer centers in India. It was divided into two main subsets: 1) The definition of surgical margins and 2) The use of frozen sections to evaluate tumor margins. Results Of 440 surveys mailed, 50 completed surveys were received. Majority of responses stated that acceptable clear margins varied according to site, and individual patient factors. Macroscopically clear surgical margins ranged between 0.5–1.5 cm. Best practice for intraoperative margin assessment was frozen tissue analysis of the entire specimen. The majority of responses for choice of sampling site were for both the surgical bed and tumor margin. The overwhelming majority defined microscopically clear margins as 5 mm of tissue or more without tumor. Conclusion No standard guidelines and strategies exist among head and neck surgeons about the definition of clear margins and the practice patterns. However, these results have to be applied on a larger sample size in order to validate and authenticate our findings.