The assessment and management of surgical margins in stage I and II oral cavity squamous cell carcinoma is one of the most important perioperative aspects of oncologic care, with profound implications for patient outcomes and adjuvant therapy. Understanding and critically reviewing the existing data surrounding margins in this context is necessary to rigorously care for this challenging group of patients and minimize patient morbidity and mortality.
This review discusses the data related to the definitions related to surgical margins, methods for assessment, specimen vs tumor bed margin evaluation, and re-resection of positive margins. The observations presented emphasize notable controversy within the field about margin assessment, with early data coalescing around several key aspects of management, although studies are limited by their design.
Conclusions and Relevance
Stage I and II oral cavity cancer requires surgical resection with negative margins to obtain optimal oncologic outcomes, but controversy persists over margin assessment. Future studies with improved, well-controlled study designs are required to more definitively guide margin assessment and management.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: April 16, 2023.
Published Online: June 8, 2023. doi:10.1001/jamaoto.2023.1201
Corresponding Authors: Sidharth Puram, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis, 660 S Euclid Ave, Box 8115, St Louis, MO 63110 (firstname.lastname@example.org); Ashley C. Mays, MD, Department of Otolaryngology, Cleveland Clinic Florida, Cleveland Clinic Indian River Hospital, 3555 10th Ct, Vero Beach, FL 32960 (email@example.com).
Author Contributions: Drs Puram and Mays had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Puram and Mays contributed equally.
Concept and design: Puram, Mays, Bayon, Fundakowski, Massa, Sharma, Varvares.
Acquisition, analysis, or interpretation of data: Mays, Bayon, Bell, Chung, Fundakowski, Johnson, Massa.
Drafting of the manuscript: Puram, Mays, Bayon, Bell, Chung, Fundakowski, Johnson, Massa.
Critical revision of the manuscript for important intellectual content: Puram, Chung, Fundakowski, Massa, Sharma, Varvares.
Statistical analysis: Mays.
Administrative, technical, or material support: Puram, Mays, Johnson, Massa, Sharma.
Supervision: Puram, Bell, Fundakowski, Sharma, Varvares.
Conflict of Interest Disclosures: None reported.
Additional Information: This work was submitted on behalf of the American Head and Neck Society Mucosal Section.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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