Due to the complex anatomy, evaluation of resection margins from oral cavity cancer specimens is difficult and not amenable to a single, simple set of guidelines. Proper orientation of the specimen requires accurate and exact communication between the surgeon and pathologist. This level of communication is particularly necessary when performing intra-operative frozen sections.

One of the chief indicators of completeness of surgical excision is the margin of uninvolved tissue surrounding the extirpated neoplasm. To facilitate optimal excision, intra-operative evaluation is frequently used to guide margins of resection. Mucosal surgical margins should be received oriented as to which side is the true surgical margin. This orientation facilitates cutting the frozen section from the appropriate surface, and therefore in the correct direction (cutting the sections toward the true margin and not toward the tumor size). The surgeon, by placing strategic sutures on the specimen and rendering a simple illustration key to the placement of the sutures, can facilitate this type of coordination.

Recent studies found that in resection specimens of squamous cell carcinoma in the head and neck the presence of lesional tissue (severe dysplasia, carcinoma in situ, or invasive carcinoma) within 5 mm of the resection margin puts a patient at equal risk for local recurrence (96). If a 5-mm negative surgical margin is to be obtained and the surgical margins are to be removed and submitted by the surgeon, it is necessary to designate for the pathologist which surface is the "true" surgical margin (96).

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