Bladder Prolapse (Cystocele) Among African, Asian, and Middle Eastern Women: A Clinical and Socio-Cultural Perspective.intraoperative Frozen Section Analysis (Ifsa): One Plastic Surgeon’s Experience With 1598 Consecutive Skin Cancer Removals

BACKGROUND: Skin cancer continues to be the most frequently diagnosed cancer in the United States. Since 1990, the prevalence of melanoma and non-melanoma skin cancer (NMSC) has been steadily increasing.1 NCCN guidelines recommend complete excision of NMSC to preserve function and optimize aesthetic outcomes.2 The gold standard surgical treatment is Mohs Micrographic Surgery (MMS) with a reported cure rate of 99-100%.3 However, MMS requires specialized training and thus is more geographically and financially limited. The traditional technique utilized for skin cancer removal is intraoperative frozen section assessment (IFSA). IFSA is a common histopathological technique that facilitates microscopic analysis of skin cancer margins intraoperatively, guiding surgical decision making.4 Given the high accessibility of IFSA, plastic surgeons can utilize IFSA when MMS is not readily available. In this study, we aim to report the efficacy of plastic surgeon’s use of IFSA for NMSC removal. METHODS: We conducted a retrospective chart review study, reporting a single plastic surgeon’s experience using the IFSA technique. The primary outcome was cancer recurrence and false negative rate, which was determined by searching the pathology lab’s patient database, for IFSA procedures between January 2016 to July 2023. A recurrence was noted when a patient experienced an excision of skin cancer demonstrated to be arising from post-excision scar tissue. Secondary outcomes include defect size, number of stages, operative time, and complications. RESULTS: There were 1598 IFSA procedures included in the final analysis. The cohort was 40.2% female and the average age was 71.6 years old. The pathology lab identified two recurrences, representing a 0.1% recurrence rate (99.9% cure rate). Eight cases (0.46%) were false negatives for which subsequent reexcision took place. Complete treatment required an average of 1.15 stages to achieve clear margins with an average operative time of 48.5 minutes (n=44). The average defect size was 2.13 cm2, and the complication rate was 3.5%. CONCLUSION: Conventional surgical excision for low risk NMSC remains the most widely available treatment, with cure rates potentially exceeding 95%. However, this method does not provide real-time feedback and may lead the surgeon to (1) incompletely excise the tumor or (2) create unnecessarily large defects. MMS utilizes this intraoperative analysis and demonstrates consistently high cure rates of 98-99%.3 However, underserved and rural communities may lack access to Mohs-trained surgeons and histotechnicians.5 Our findings suggest that plastic surgeons can use traditional IFSA as an effective surgical technique in treatment of NMSC with a 99.9% cure rate.