Intraoperative Molecular Margin Analysis in Head and Neck Cancer

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Abstract
Head and neck squamous cell carcinoma (HNSCC) is a devastating and life-threatening disease with a high incidence of morbidity and mortality in advanced disease. More than 40 000 new cases of HNSCC are diagnosed in the United States and more than 500 000 worldwide each year. Despite aggressive surgical and other therapies, more than 50% of all patients have advanced disease at the time of diagnosis, and many of these ultimately die of local or regional recurrence. The adequacy of surgical resection of the primary tumor is conventionally determined intraoperatively by histologic hemotoxylin-eosin diagnosis using frozen section margins.1 The presence of microscopic tumor at the surgical margins is associated with increased local recurrence and reduced survival.2 However, despite apparent complete gross and microscopic excisions of primary HNSCC, there is a significant rate of local recurrence in patients with histologically negative margins.3