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Details of the process of margin control surgery (MCS) may seem daunting to a skin surgeon contemplating its introduction to their practice. This simple basal cell carcinoma (BCC) illustrates how straightforward the process can be. Doctors who refer out MCS cases may wish to explain the process to patients by showing them a case like this one.
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An 82-year-old man was referred for MCS with a lesion on the cheek. It had grown slowly over months and had recently started to crust and bleed (Fig. 15.1). Clinically, it was thought to be a classic nodular BCC.
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Following the usual preoperative procedures (including discussion of the procedure and consents), the lesion was demarcated with a pen (Fig. 15.2). Dermatoscopy helped to delineate the margins radially.
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Local anesthetic was injected (Fig. 15.3).
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Curettage was performed (Fig. 15.4). The patient did not have a preoperative biopsy, so the curettage biopsy was immediately processed as a frozen section to confirm the diagnosis of BCC. The tumor extended further than expected with the curettage and a new margin was demarcated with a pen and a notch made for orientation (Fig. 15.5).
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The first level was excised (Fig. 15.6). The bevel angle was around 45°.
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The specimen was orientated by creating a single notch. As this was a small uncomplicated lesion, a single notch was sufficient. The specimen was carefully laid out on a gauze with the notch facing a ...