Dermatology "Squares"

[yaah]

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OK, I have to know. Has anyone EVER heard of this technique before for excising lesions? Usually done for melanoma - they cut a 2 mm or so rim of skin around the edge of the lesion and send it for histology. If that is negative, they excise the main tumor and they are done. If positive, they do another square. It's kind of like frozen section margins, but done with a several day turnaround time.

The reason they are a pain in the ass is we have to gross them in - the inking regimen is quite complex and annoying. Each edge is oriented (blue ink at one edge, green at the other) so that if you see tumor on the slide you know exactly where the positive margin is. And we have to be careful to correctly indicate the side to be embedded first.

Usually they do this for head and neck melanomas/MIS. I despise them. And I had never heard of such a technique before I came here.

Part of the problem is that sometimes the squares have about eight sides to them. 😱

 

[b&ierstiefel]

I have no clue what you're talking about.

I shall now bust out my "WTF" stamp.

*BONK!*

WTF.

 

[LADoc00]

OK, I have to know. Has anyone EVER heard of this technique before for excising lesions? Usually done for melanoma - they cut a 2 mm or so rim of skin around the edge of the lesion and send it for histology. If that is negative, they excise the main tumor and they are done. If positive, they do another square. It's kind of like frozen section margins, but done with a several day turnaround time.

The reason they are a pain in the ass is we have to gross them in - the inking regimen is quite complex and annoying. Each edge is oriented (blue ink at one edge, green at the other) so that if you see tumor on the slide you know exactly where the positive margin is. And we have to be careful to correctly indicate the side to be embedded first.

Usually they do this for head and neck melanomas/MIS. I despise them. And I had never heard of such a technique before I came here.

Part of the problem is that sometimes the squares have about eight sides to them. 😱

One day Daniel-san, you will realize that so much money comes from derm even for a small little community practice (a reasonably busy dermatologist can easily send you 20grand per MONTH in biz, gross that is tho), that you will kiss their unshaven sphincters reflexively, let alone doing this ritualistic torturous grossing you describe.

Seriously, when little baby Yaah looks up at you wondering why he has no food in his baby bowl because daddy decided he was too good for doing either this or FNAs, you might think again.......

 

[yaah]

I they want to pay me, I will do the freaking squares. But we only get 88305 for them now, and they take about 10x the amount work and supplies.

 

[LADoc00]

I they want to pay me, I will do the freaking squares.

that's my boy, good job. baby yaah eat well tonight!

 

[Pingu]

Send em to me, I love to ink stuff! And draw little diagrams too!

 

[DarksideAllstar]

How can a square have eight sides. WTF?
And no.

 

[xanthines]

Is that some variant on Mohs surgery?

Maybe it was developed by a Dr Squares?

-X

OK, I have to know. Has anyone EVER heard of this technique before for excising lesions? Usually done for melanoma - they cut a 2 mm or so rim of skin around the edge of the lesion and send it for histology. If that is negative, they excise the main tumor and they are done. If positive, they do another square. It's kind of like frozen section margins, but done with a several day turnaround time.

The reason they are a pain in the ass is we have to gross them in - the inking regimen is quite complex and annoying. Each edge is oriented (blue ink at one edge, green at the other) so that if you see tumor on the slide you know exactly where the positive margin is. And we have to be careful to correctly indicate the side to be embedded first.

Usually they do this for head and neck melanomas/MIS. I despise them. And I had never heard of such a technique before I came here.

Part of the problem is that sometimes the squares have about eight sides to them. 😱

 

[djmd]

How can a square have eight sides. WTF?
And no.

I believe that the the derm Hyper cube margin.
and no aka WTF.

We do an ellipse, two inks for lateral margins and a different for deep.

 

[Aubrey]

Is that some variant on Mohs surgery?

Concur, this sounds a lot like Mohs, with the surgeon sending out permanents for verification or some such.. always nice for derm to toss a few bones our way. 🙄

 

[yaah]

A square can have 8 sides when it is an octogon. The "square" just refers to the type of procedure. Most of the time it is a square, but not always. Today, for example, I got two squares. One was a full excision, diamond shaped, of skin with the lesion in the center. But they want the margins treated like a square. So they are all shaved, and inked appropriately, etc. The other is a portion of a square - three sided, because one of the prior margins was positive, so they took another margin and didn't care about the one opposite to it. Basically, it is a "mapped" margin excision to precisely determine sites of positivity.

Here is the citation. Big freaking surprise, the main authors are our director of dermpath, our former director of dermpath, and the guy who runs the Mohs unit.

http://www.ncbi.nlm.nih.gov/entrez/...t_uids=9366823&query_hl=1&itool=pubmed_docsum

 

[yaah]

Apparently they do these things at Utah too.

 

[Nilf]

A square can have 8 sides when it is an octogon. The "square" just refers to the type of procedure. Most of the time it is a square, but not always. Today, for example, I got two squares. One was a full excision, diamond shaped, of skin with the lesion in the center. But they want the margins treated like a square. So they are all shaved, and inked appropriately, etc. The other is a portion of a square - three sided, because one of the prior margins was positive, so they took another margin and didn't care about the one opposite to it. Basically, it is a "mapped" margin excision to precisely determine sites of positivity.

Here is the citation. Big freaking surprise, the main authors are our director of dermpath, our former director of dermpath, and the guy who runs the Mohs unit.

http://www.ncbi.nlm.nih.gov/entrez/...t_uids=9366823&query_hl=1&itool=pubmed_docsum

these are referred to as 'slow Mohs' I believe. Basically, the patient has an open wound until dermpath confirms that the margins are negative. And yes, the biopsies tend to be very colorful, because every edge has to have different color. Sometimes we get a 10 mm biopsy, from which we have to shave the edge, color them, submit each edge separatedly, and then submit the core. Fun fun fun.