The Feasibility of Computer Simulations and 3-Dimensional-Printed Resection Guides for Skin Cancer Resection

Abstract

The surgical resection margin in skin cancer is traditionally determined by the lesion's surface boundary without 3-dimensional information. Computed tomography (CT) can offer additional information, such as tumor invasion and the exact cancer extent. This study aimed to demonstrate the clinical application of and to evaluate the safety and accuracy of resection guides for skin cancer treatment. This prospective randomized comparison of skin cancer resection with (guide group; n=34) or without (control group; n=28) resection guide use was conducted between February 2020 and November 2021. Patients with squamous cell carcinoma or basal cell carcinoma were included. In the guide group, based on CT images, the surgical margin was defined, and a 3-dimensional-printed resection guide was fabricated. The intraoperative frozen biopsy results and distance from tumor boundary to resection margin were measured. The margin involvement rates were 8.8% and 17.9% in the guide and control groups, respectively. The margin involvement rate was nonsignificantly higher in the control group as compared with the guide group ( P =0.393). The margin distances of squamous cell carcinoma were 2.3±0.8 and 3.4±1.6 mm ( P =0.01) and those of basal cell carcinoma were 2.8±1.0 and 4.7±3.2 mm in the guide and control groups, respectively ( P =0.015). Margin distance was significantly lower in the guide group than the control group. The resection guide demonstrated similar safety to traditional surgical excision but enabled the minimal removal of normal tissue by precisely estimating the tumor border on CT scans.