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Original Investigation
From the American Head and Neck Society
December 2017

Definition of “Close Margin” in Oral Cancer Surgery and Association of Margin Distance With Local Recurrence Rate

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
JAMA Otolaryngol Head Neck Surg. 2017;143(12):1166-1172. doi:10.1001/jamaoto.2017.0548
Key Points

Question  In oral cavity squamous cell carcinoma (OCSCC), is there an association between specific margin distances and local recurrence, and what should be considered a “close” margin?

Findings  In this retrospective cohort study of 432 patients with OCSCC, there was no appreciable difference between local recurrence rates for different margin distances of 1 mm or greater. Regardless of the specific margin distance, resection of additional tissue after a positive frozen section margin did not significantly alter local recurrence rate.

Meaning  A cutoff of less than 1 mm between cut tissue edge and invasive tumor would be appropriate to consider as a close margin at risk for recurrence.


Importance  There is a lack of consistency in the literature regarding the definition of “close” resection margins in the surgical treatment of oral cavity squamous cell carcinoma (OCSCC), and the relationship between local recurrence (LR) rates and different distances of invasive tumor from surgical margin is not well characterized.

Objective  To analyze the association between specific distances from invasive tumor to surgical margin and LR in patients with OCSCC.

Design, Setting, and Participants  Retrospective cohort study of 432 patients treated via en bloc resection for OCSCC between 2005 and 2014 at the University of Iowa Hospitals and Clinics. In all cases, permanent margin evaluation was performed on the main tumor specimen and with intraoperative frozen section margin assessment from the tumor bed.

Main Outcomes and Measures  The LR rate based on minimum millimeter distance between invasive tumor and inked main specimen margin.

Results  Of the 432 participants, 252 (58%) were men and 180 (42%) were women (mean age, 62.14 years; range, 19-99 years). In each case, the LR rate was analyzed in relation to each millimeter distance of invasive cancer from the inked main specimen margin, with results showing an exponential inverse relationship. The LR rate for microscopic positive margins was 44% (95% CI, 34%-55%); for margins less than 1 mm, 28% (95% CI, 18%-41%); for 1 mm, 17% (95% CI, 8%-31%); for 2 mm, 13% (95% CI, 6%-27%); for 3 mm, 13% (95% CI, 5%-32%); for 4 mm, 14% (95% CI, 5%-35%); and for 5 mm or greater, 11% (95% CI, 6%-18%). Analysis of the receiver operating characteristic curve identified a cutoff of less than 1 mm as appropriate for classifying higher risk of local recurrence. Regardless of margin distance, resection of additional tissue beyond 1 mm based on intraoperative frozen section was not associated with improved local control.

Conclusions and Relevance  The commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence. Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence rate, though there is no significant difference for greater distances. This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen rather than the tumor bed is necessary for this determination.