Very large re-excision specimens

Pathology of challenging melanocytic neoplasms. Diagnosis and Management. Christopher R. Shea, Jon A. Reed, Victor G. Prieto (Editors). Springer (2015)

Very large excisional specimens, often taken for treatment of broad malignant melanomas, pose a unique challenge. These specimens may be marked with ink to reflect orientation similar to a small excision, but serial sectioning may result in pieces of tissue still too large to fit into a cassette for tissue processing. In this scenario, the prior biopsy site and residual primary tumor should be removed en bloc, serially sectioned, and entirely submitted as if it was an elliptical excision. Peripheral margins closet to the en bloc excision are then serially sectioned to document the peripheral margins. En face peripheral margins may be employed for extremely large specimens in which serial sections perpendicular to the primary lesion are still too large. En face sections, however, are not optimum for evaluating margins of lentigo maligna as distinction from melanocyte hyperplasia reflective of the background actinic changes may be difficult without use of additional special studies such as immunohistochemistry [7, 8].

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