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BACKGROUND

Frozen section (FS) is commonly used for intraoperative margin assessment in oral cavity squamous cell carcinoma (OCSCC). Its value in recurrent or previously treated cases, however, remains uncertain.

METHODS

We retrospectively analyzed prospectively collected data from 510 patients with histologically confirmed OCSCC treated between April 2018 and August 2022. Patients were divided into Group A (recurrent/second primaries/previously treated, n = 247) and Group B (treatment-naïve, n = 263). A 1-cm gross margin was targeted for all resections. FS and permanent sections were reviewed by three institutional pathologists. Margins were defined as positive (tumor/ moderate to severe dysplasia at the cut edge or < 1 mm), close (1-5 mm), and free (> 5 mm). Primary outcomes included initial FS margin status, number of additional resections (recuts), and final histopathology margin status.

RESULTS

On initial FS, a significantly higher proportion of patients in Group A had close or positive margins (34.41%, 85/247) compared to Group B (1.52%, 4/263), with the difference being highly statistically significant (p < 0.0001). After intraoperative revision, 72 of the 85 patients (84.70%) in Group A achieved negative margins on a second margin revision, and an additional 9 patients (10.58%) required a third margin revision to achieve negative margins. Overall, only 4 of the 510 patients (0.78%) in the entire cohort had close or positive margins on final histopathology, and all four were from Group A. On final HPE, 3 patients had close margins and 1 had a persistent positive margin.

CONCLUSION

Gross examination with an adequate margin may be sufficient for treatment-naïve OCSCC. However, for previously treated cases, FS significantly aids in achieving intraoperative margin clearance and reduces final positive margins. The study's primary aim was not to assess oncologic outcomes, but rather to emphasize the necessity of FS in complex cases who had undergone multiple prior treatments where gross inspection is unreliable.