Background
Surgical marking of nonmelanocytic skin cancers (NMSC) is becoming more dependent on the surgeon’s perception of an appropriate estimated excisional border rather than relying on the accuracy of measuring with a ruler. By measuring the appropriate border as per cancer guidelines surgical re-excision rates may be reduced. This study reviewed health professionals’ ideas of a 5mm margin/border against that of a measured 5mm margin using a ruler.
Method:
A questionnaire was conducted with 200 participants identifying their level of qualification, surgical skin excision exposure, their need for corrective glasses, age and gender. The participants then had to draw a 5mm margin around a photograph of a squamous cell carcinoma(SCC) with well-defined borders on the right cheek. These margins were then measured with a ruler in four directions to identify the accuracy of the participants’ perceived 5mm margin.
Results:
No participant was 100% accurate when marking a 5mm border circumferentially around an SCC on the face. Four participants were excluded as they didn’t mark a border and rather marked an ‘X’ on the lesion. A total of 8% of participants (16/196) had 3 quadrants correctly marked. There was a statistical significance noted with all 16 participants, with female participants showing the greatest degree of accuracy. Forty-nine percent didn’t identify any borders correctly(96/196). There was no statistical significance between different age groups or participants who wore visual correction.
Conclusion:
The accuracy of a ruler is invaluable when pre-surgically marking an NMSC compared with the surgeon’s estimated 5mm border. The use of a ruler should be included in routine practice to meet the surgical excision margin guidelines thereby reducing the risk of re-excision by marking an inappropriate border than that recommended by cancer guidelines. Identifying an accurate border for excision is presumed to also assist with presurgical planning for an appropriate reconstruction.