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| Nasal fibrosarcoma in an 8-year-old German shepherd. Photo courtesy of Dr. Phil Zeltzman |
Music critics claim that Sade’s song “Never as Good as the First Time” applies to personal relationships. We beg to differ. She was clearly referring to cancer surgery.
The best time to obtain clean margins during surgical excision of a malignant tumor is the first time. The most aggressive, i.e. mitotically active, cells are not located in the main, visible or palpable mass, but within its “legs” or tentacles. This is why it is so important to obtain clean margins the first time around.
Dirty margins will require radiation therapy, chemotherapy or a more aggressive excision to prevent a recurrence. Re-excision is always more complicated because it is difficult, if not impossible, to know how invasive we should be. The original tumor may have seeded cells in multiple tissue planes during the first attempt.
One easy way to think of the cancerous mass during the first excision is to consider it as grossly infected (read: covered in pus). Therefore, it shouldn’t come in contact with healthy tissues. Gloves, instruments and drapes should be changed before closing the surgical site.
It also is important to remove tumors en bloc. In other words, the main mass should not be shelled out with the intention of removing more tissue afterward.
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| Mast cell tumor on the hock of a 6-year-old boxer. Photo courtesy of Dr. Phil Zeltzman |
The deep margin ofte...
Copyright 2009 BowTie Inc.
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