Purpose: When an initial "excisional biopsy" has been performed on a primar
y oral carcinoma, microscopic tumor may remain and the usual landmarks that
enable the surgeon to plan his safe margin are destroyed. This article ana
lyzes the impact that such a biopsy may have on treatment and patient outco
me.
Patients and Methods: A retrospective chart review of a consecutive series
of 350 oral cancer patients treated by 1 surgeon in an 8-year period identi
fied 33 (9.4%) patients who originally had inadequate excisional biopsies.
Exclusion criteria eliminated 7 patients who were lost to follow-up or who
had undergone previous treatment with radiation therapy or chemotherapy. Da
ta extracted included age, sex, race, primary intraoral site, estimated tum
or (T) stage, method of treatment, histology, follow-up, and outcome.
Results: Twenty-four of the 26 patients underwent re-excision of their oral
cancer. Ten of these patients (38.4%) also underwent selective neck dissec
tion. Fifteen of the 24 patients (62.5%) had residual carcinoma identified
in the re-excision specimen, and 3 of the patients who underwent elective n
eck dissection had micrometastasis identified. The patients were followed f
or an average of 35.5 months. Two of 24 (8.3%) patients had local recurrenc
e at 36 and 84 months, respectively. Both patients were managed with re-exc
ision and are still alive with no evidence of disease. Of the 10 patients o
riginally treated with elective neck dissection, there has been no regional
recurrence. However, of the 14 patients who underwent re-excision of the l
esion without neck dissection, 3 developed regional disease at 1, 5, and 6
months, respectively, postoperatively. These patients underwent neck dissec
tion and radiation therapy. Two patients are alive with no evidence of dise
ase, and the third died of a second primary lung cancer. Twenty-five of the
26 patients (96.2%) are still alive and well with no evidence of disease.
Conclusions: Patients who have had inadequate excisional biopsies can be ef
fectively managed with re-excision plus neck dissection when indicated by T
stage or more than 3 mm depth of invasion. (C) 2001 American Association o
f Oral and Maxillofacial Surgeons.