Intraoperative frozen biopsy in wide surgical excision of Paget's disease of the scrotum

Abstract 

Objective

To determine if there is an advantage to performing intraoperative frozen biopsy to ascertain clear surgical margins in wide surgical excision for Paget's disease of the scrotum.

Patients and methods

We retrospectively reviewed surgical and pathological records of 133 patients with Paget's disease of the scrotum who were treated with wide surgical excision from 1993 to 2008.

Results

A total of 51 cases had intraoperative frozen biopsy of the surgical margins. Of these, 17 had margins positive for Paget's disease, thus a wider area was excised and the sample examined again. In all instances, result of the final pathologic examinations after surgery indicated margins were negative. In the 82 cases that did not have intraoperative frozen biopsy, 31 were found to have tumor cells at the surgical margin by pathologic examination. Of these 31 patients, 24 had a second surgery after which surgical margins were clear. The other 7 patients refused a second surgery. Of the patients who refused a second surgery, 5 had recurrent disease.

Conclusion

Determination of the extent of lesions and margins for surgical excision by visualization is inadequate. The routine use of intraoperative frozen biopsy reduces the incidence of positive surgical margins in surgical excision of Paget's disease of the scrotum.

Keywords: Paget's disease of scrotum, Surgical excision, Intraoperative frozen biopsy