CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancers, especially skin cancers.[1][2]
A classical example of CCPDMA is Mohs surgery. Other examples of CCPDMA are found in classical pathology textbooks as techniques of cutting surgical specimens to allow the examination of the inferior and lateral margins of typically elliptical surgical specimens. CCPDMA is superior to standard bread loafing due to very low false negative error rate. Bread loafing extrapolates the margin exam of a few representative slides to the entire surgical margin. CCPDMA allows for the complete examination of the surgical margin without statistical extrapolation and assumptions.
The first advantage of CCPDMA method is that it allows for the complete examination of the entire surgical margin of the specimen. The second advantage of CCPDMA is allowing the surgeon to remove only a very small surgical margin. As the CCPDMA surgery is frequently performed using frozen section pathology, immediate reporting of positive surgical margin is made, and the tumor can be completely removed in the same day. Traditional pathology processing is called "bread loafing", and only allows for the partial examination of the surgical margin. Many surgeons send the specimen out for processing, and the result of the surgical margin assessment is not made until days later.[3]
However CCPDMA is subject to the basic principles of histology sectioning. From a physical standpoint the true margin is never assessed due to the fact that an en face margin has to be cut through in order to make the slide for examination, therefore a true assessment of margins is never achieved. Additionally simple normal hair follicles mimic the cells seen in common skin cancers such as basal cell carcinoma and should be assessed by someone experienced in histopathologic examination such as a board-certified pathologist or dermatopathologist.
References
- ^ http://wwwu.tsgh.ndmctsgh.edu.tw/commcpc/images/nccn/Non-Melanoma%20Skin%20Cancer-2007.pdf
- ^ http://wwwu.tsgh.ndmctsgh.edu.tw/commcpc/images/nccn/dfsp%20NCCN%202004.pdf
- ^ Kimyahi-Asadi A, et al. Dermatol Surg. 2007 Dec;33(12):1434-9; discussion 1439-41. Margin involvement after the excision of melanoma in situ: the need for complete en face examination of the surgical margins.