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Head and Neck Cancer

Margins in Stage I and II Oral Cavity Squamous Cell CarcinomaA Review From the American Head and Neck Society

To identify the key insights or developments described in this article

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: June 8, 2023

Review

Article Information and Disclosures

Sidharth V. Puram, MD, PhD^1,2;

Ashley C. Mays, MD³;

Rodrigo Bayon, MD⁴;

Diana Bell, MD⁵;

Jeffson Chung, MD⁶;

Christopher E. Fundakowski, MD⁷;

Bradley T. Johnson, MD⁸;

Sean T. Massa, MD⁹;

Arun Sharma, MD, MS¹⁰;

Mark A. Varvares, MD¹¹

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
²Department of Genetics, Washington University in St Louis, St Louis, Missouri
³Department of Otolaryngology, Cleveland Clinic Florida, Cleveland Clinic Indian River Hospital, Vero Beach
⁴Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
⁵City of Hope Comprehensive Cancer Center, Duarte, California
⁶Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown
⁷Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
⁸Ear, Nose, Throat and Plastic Surgery Associates, AdventHealth, Winter Park, Florida
⁹Department of Otolaryngology–Head and Neck Surgery, St Louis University, St Louis, Missouri
¹⁰Department of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
¹¹Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston

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Abstract

Importance 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.

Observations 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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Article Information

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 (sidpuram@wustl.edu); Ashley C. Mays, MD, Department of Otolaryngology, Cleveland Clinic Florida, Cleveland Clinic Indian River Hospital, 3555 10th Ct, Vero Beach, FL 32960 (maysa3@ccf.org).

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.

AMA CME Accreditation Information

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:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.