CCPDMA
Encyclopedia
CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancer
s, especially skin cancer
s.
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.
However CCPDMA is subject to the basic principles of histology sectioning. From a physical standpoint the true margin is never assessed because 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. With serial sectioning, the Mohs method of CCPDMA approaches near complete evaluation of the surgical margin. Usually, CCPDMA is performed by pathologists, dermatologists, and surgeons trained in the Mohs micrographic method (Dr. Frederick Mohs).
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s, especially skin cancer
Skin cancer
Skin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...
s.
A classical example of CCPDMA is Mohs surgery
Mohs surgery
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. It is one of the many methods of obtaining complete margin control during removal of a skin cancer using frozen section...
. Other examples of CCPDMA are found in classical pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
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
Bread loafing
Bread loafing is a common method of processing surgical specimen for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then thinly sliced with a microtome or a cryostat...
due to very low false negative error rate. Bread loafing extrapolates the margin exam of a few representative slides to the entire surgical margin
Surgical margin
Surgical margin, also known as tumor free margin, free margin, normal skin margin, and normal tissue margin, usually refers to the visible normal tissue or skin margin that is removed with the surgical excision of a tumor, growth, or malignancy.-Definition:Surgical margin in a surgery reports...
. 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
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
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.
However CCPDMA is subject to the basic principles of histology sectioning. From a physical standpoint the true margin is never assessed because 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. With serial sectioning, the Mohs method of CCPDMA approaches near complete evaluation of the surgical margin. Usually, CCPDMA is performed by pathologists, dermatologists, and surgeons trained in the Mohs micrographic method (Dr. Frederick Mohs).