口腔扁平上皮癌に対するExcisional biopsyの適応と実際

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  • Indication and treatment modality of excisional biopsy for squamous cell carcinoma of the oral cavity

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Incisional biopsy is routinely performed to determine their malignancy; however, incision into a neoplasm could help it to spread or could even increase its malignancy. Because direct inspections and digital palpations are possible for lesions of the oral cavity, close examination by surgeons make it possible to determine the malignancy of the lesion. Thus, we employ excisional biopsy for small and localized oral carcinomas as surgical treatment directing at controlling the primary tumor, to prevent spreading cancer cells by incisional biopsy. In our principles, we adopt excisional biopsy for oral carcinomas, which could be effectively treated with simple excision of the primary lesions. To determine their malignant potential, we evaluate the depth of invasion by intraoral ultrasonography (usD) based on the clinical growth pattern. Superficial and exophytic tumors less than 15 mm in usD should be simply excised combined with vital staining with Lugol. Furthermore, endophytic tumors less than 8 mm in usD could be treated by excisional biopsy with preoperative chemotherapy. To obtain tumor-free margins, we have performed concave or box-shape excision combined with intraoperative rapid frozen section diagnosis. In conclusions, excisional biopsy is an effective treatment to improve prognosis and quality of life of the patients with oral carcinoma.

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