Does the extent of the surgical margin affect the likelihood of local recurrence in Patnaik grade I or II cutaneous mast cell tumours?
Clinical bottom line
Category of research question
The number and type of study designs reviewed
Eight papers were critically reviewed. Five were retrospective case series, two prospective clinical trials, and one prospective case series
Strength of evidence
Sequin et al. (2001) reported a local recurrence rate of 5%, but this study is 20 years old. In the studies of Simpson et al. (2004), Fulcher et al. (2006), Pratschke et al. (2013), Saunders et al. (2020), and Itoh et al. (2021), no local recurrence was observed in grade I and II mast cell tumours, while in the Milovancev et al. (2019) study, only 1/30 low-grade cutaneous mast cell tumors developed local recurrence. Therefore, there is some evidence that conservative surgical excision is sufficient to achieve local control with low recurrence rates
There is increasing evidence in the literature for conservative surgical excision of grade I and II MCTs, but because the quality of evidence is low, no clear recommendations can be made. Further studies are needed to determine recommendations for surgical excision of cutaneous MCTs based on the biological characteristics of the tumour and the completeness of histologic margins
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Chu, M., Hayes, G., Henry, J. & Oblak, M. (2020). Comparison of lateral surgical margins of up to two centimeters with margins of three centimeters for achieving tumor-free histologic margins following excision of grade I or II cutaneous mast cell tumors in dogs. Journal of the American Veterinary Medical Association. 256(5), 567–572. DOI: https://doi.org/10.2460/javma.256.5.567
Fulcher, R., Ludwig, L., Bergman, P., Newman, S., Simpson, A. & Patnaik, A. (2006). Evaluation of a two-centimeter lateral surgical margin for excision of grade I and grade II cutaneous mast cell tumors in dogs. Journal of the American Veterinary Medical Association. 228(2), 210–215. DOI: https://doi.org/10.2460/javma.228.2.210
Hillman, L., Garrett, L., de Lorimier, L., Charney, S., Borst, L. & Fan, T. (2010). Biological behavior of oral and perioral mast cell tumors in dogs: 44 cases (1996–2006). Journal of the American Veterinary Medical Association. 237(8), 936–942. DOI: https://doi.org/10.2460/javma.237.8.936
Itoh, T., Kojimoto, A., Uchida, K., Chambers, J. and Shii, H. (2021). Long-term postsurgical outcomes of mast cell tumors resected with a margin proportional to the tumor diameter in 23 dogs. Journal of Veterinary Medical Science. 83(2), 230–233. DOI: https://doi.org/10.1292/jvms.20-0281
Milovancev, M., Townsend, K., Tuohy, J., Gorman, E., Bracha, S., Curran, K. and Russell, D. (2019). Long‐term outcomes of dogs undergoing surgical resection of mast cell tumors and soft tissue sarcomas: A prospective 2‐year‐long study. Veterinary Surgery. 49(1), 96–105. DOI: https://doi.org/10.1111/vsu.13225
Monteiro, B., Boston, S. & Monteith, G. (2011). Factors influencing complete tumor excision of mast cell tumors and soft tissue sarcomas: a retrospective study in 100 dogs. Canadian Veterinary Journal. 52(11), 1209–1214.
Pratschke, K., Atherton, M., Sillito, J. & Lamm, C. (2013). Evaluation of a modified proportional margins approach for surgical resection of mast cell tumors in dogs: 40 cases (2008–2012). Journal of the American Veterinary Medical Association. 243(10), 1436–1441. DOI: https://doi.org/10.2460/javma.243.10.1436
Saunders, H., Thomson, M., O'Connell, K., Bridges, J. & Chau, L. (2020). Evaluation of a modified proportional margin approach for complete surgical excision of canine cutaneous mast cell tumours and its association with clinical outcome. Veterinary and Comparative Oncology. 19(4). DOI: https://doi.org/10.1111/vco.12630
Seguin, B., Leibman, N., Bregazzi, V., Ogilvie, G., Powers, B., Dernell, W., Fettman, M. & Withrow, S. (2001). Clinical outcome of dogs with grade-II mast cell tumors treated with surgery alone: 55 cases (1996–1999). Journal of the American Veterinary Medical Association. 218(7), 1120–1123. DOI: https://doi.org/10.2460/javma.2001.218.1120
Sfiligoi, G., Rassnick, K., Scarlett, J., Northrup, N. & Gieger, T. (2005). Outcome of dogs with mast cell tumors in the inguinal or perineal region versus other cutaneous locations: 124 cases (1990–2001). Journal of the American Veterinary Medical Association. 226(8), 1368–1374. DOI: https://doi.org/10.2460/javma.2005.226.1368
Simpson, A., Ludwig, L., Newman, S., Bergman, P., Hottinger, H. and Patnaik, A. (2004). Evaluation of surgical margins required for complete excision of cutaneous mast cell tumors in dogs. Journal of the American Veterinary Medical Association. 224(2), 236–240. DOI: https://doi.org/10.2460/javma.2004.224.236
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