After resection of a lateral tongue squamous carcinoma, the final deep margin contains invasive tumour. What is the preferred principle when anatomically feasible?
A truly involved margin is a powerful local-recurrence risk. Re-resection is preferred where it can obtain clearance without disproportionate morbidity; otherwise postoperative chemoradiotherapy is considered.
A. No further treatment because the specimen was removed en bloc: Histological involvement means disease may remain.
B. Antibiotics and interval biopsy: This does not address residual malignancy.
C. Neck irradiation alone: The primary-bed risk must be treated.
D. Offer further resection to achieve a clear margin before relying on adjuvant treatment: A truly involved margin is a powerful local-recurrence risk. Re-resection is preferred where it can obtain clearance without disproportionate morbidity; otherwise postoperative chemoradiotherapy is considered.
E. Surveillance imaging only: Imaging cannot reliably exclude microscopic residual disease.
If the close area were created only by specimen shrinkage and separately submitted tumour-bed margins were clear, the MDT would reconcile pathology and operative anatomy before re-resection.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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