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. 2020 Dec;46(12):1473-1480.
doi: 10.1097/DSS.0000000000002354.

Adherence to the National Comprehensive Cancer Network Criteria of Complete Circumferential Peripheral and Deep Margin Assessment in Treatment of High-Risk Basal and Squamous Cell Carcinoma

Melissa J Danesh  1 , Tyler D Menge  1 , Lydia Helliwell  2 , Meera Mahalingam  3 , Abigail Waldman  4
Affiliations

Adherence to the National Comprehensive Cancer Network Criteria of Complete Circumferential Peripheral and Deep Margin Assessment in Treatment of High-Risk Basal and Squamous Cell Carcinoma

Melissa J Danesh et al. Dermatol Surg. 2020 Dec.

Abstract

Background: The National Comprehensive Cancer Network (NCCN) has established guidelines for the treatment of keratinocyte carcinomas (KCs). Complete circumferential peripheral and deep margin assessment (CCPDMA) is recommended for "high-risk" tumors that cannot be closed primarily. If flap or grafts are needed and CCPDMA was not used, it is recommended that reconstruction be delayed until achieving clear margins.

Objective: To measure provider utilization rates of the NCCN guidelines for high-risk KCs and assess barriers that are limiting adherence.

Materials and methods: A ten-item questionnaire was distributed to NCCN nonmelanoma skin cancer panel members and physicians participating in KC treatment at academic institutions.

Results: Response rate was 49% (57/116). Responses were categorized by practice area: Mohs surgery, pathology, and other specialties: General Dermatology, Otolaryngology, Plastic Surgery, Surgical Oncology, Radiation Oncology, and Oral and Maxillofacial Surgery. Mohs surgeons were most likely to use CCPDMA for tumors meeting NCCN criteria with 14/15 using this technique in a majority of their cases, versus 2/6 pathologists and 10/16 specialists from other fields. Reasons cited for not using CCPDMA included deference to pathologists to determine the appropriate method for margin assessment and logistical difficulty.

Conclusion: Further efforts are needed to increase adherence to NCCN's guidelines regarding CCPDMA in KCs.

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