A Surgical Technique That Will Help Clear Skin Cancer Margins
BENEFITS OF CURETTING
Do you curette prior to excising a non-melanoma skin cancer?
If not, this article will discuss how the use of curettage allows the dermatology provider to define tumor borders more precisely before excision, increasing the likelihood of clearing the skin cancer and obtaining clear margins.
WATCH VIDEO
Watch THE VIDEO showing you this technique to get a better understanding on how to perform it.
In the video, I will share with you my curetting tips and how to typically mark excisions utilizing the recommended skin cancer margins.
You will learn how to appropriately mark 2 important margins:
- The Skin Cancer margin
- The Excisional margin
Learning this will help be a game changer, and it will also help you improve your patient's chance of not having to return back to clinic due to "positive margins" results.
CASE STUDY REVIEW
In the video, this patient had a superficial, nodular BCC to the right arm.
In the beginning of the video, you will see the yellow line is the skin cancer margin, where I mark the edges of where the biopsy was taken and where the skin cancer appears clinically evident.
Then, the blue line is the excisional margin, the skin marked after the cancer margin line utilizing the recommended excisional margins for clearance. In this case study, I used 4 mm margins.
You will notice after curettage, the curetted bleeding edges extended beyond the yellow cancer margin line.
Knowing this increases the likelihood of having positive margins.
I then proceed and remark the borders extending wider to improve tumor clearance rate.
The skin after the yellow cancer margin line should have NO curetted, bleeding edges and include only clinically normal appearing skin.
The results for this patient came back and…Margins Clear!
The video continues to explain how this technique proves beneficial in nonaggressive BCC tumors with clinically distinct borders (e.g. superficial, nodular).
CONSIDERATIONS WHEN CURETTING MAY NOT BE AS EFFECTIVE
Note, this is less effective in aggressive growth BCCs (e.g. fibrosing, sclerosing, morpheaform, and micronodular).
In another study, it also found to be less effective fro SCCs.
These results are explained to be because BCCS have a soft stroma relative to the dermis, which makes it easier to precisely determine the clinical extend of the lesion.
Whereas SCCs, at times, do not have a soft stroma, relative to the dermis, making curettage less helpful and more difficult to determine cancer margins.
REMEMBER THESE 5 TIPS
In summary, these are the "5 Curetting Tips You Must Know Prior to Excising a NMSC" to help clear skin cancer margins:
- Curettage before excision of nonagressive BCCs are more effective
- Aggressive BCCs are less effective
- SCCs are less effective
- If curetted edges go beyond original marked cancer margin line, remark with wider margins to increase likelihood of margin clearance
- Mohs surgery should be highly considered for aggressive BCCs and SCCs
Leverage Your Skills
As dermatology NPs/PAs, I hope this week's information helped you better understand a surgical pearl to be mindful of next time you perform surgery.
Start applying this technique right away to start building your confidence, and you will start seeing how you are helping your patients achieve the best results!
I would love to hear your feedback or any thoughts you have that, maybe, you experienced in your clinic and may want to share!
Just simply reply to this post and l will be sure to get back to you!
I look forward to hearing from you!
All my BEST,
Theresa Talens DNP, FNP-C (TheresaSurgDermNP)
P.U.L.S.E. Dermatology & Procedures, Inc.
Where we believe in Precision. Ultimate Care. Leverage. Skills. Excellence.
Sources:
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Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer. https://pubmed.ncbi.nlm.nih.gov/11074693/
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Combined curettage and excision: a treatment method for primary basal cell carcinoma. https://pubmed.ncbi.nlm.nih.gov/2033139/
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Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer. https://www.jwatch.org/jd200011220000002/2000/11/22/utility-curettage-before-skin-cancer-excision
