• remains the ideal and most frequently used

SURGERY-
treatment method.
• may be the primary method of treatment, prop
hylactic, diagnostic, palliative, or reconstructi
ve
is the definitive method of identifying
A. Diagnostic the cellular characteristics that influence
all treatment decisions.

a. EXCISION BIOPSY
b. INCISIONAL BIOPSY
c. NEEDLE BIOPSY
 Biopsy [BIO =LIFE OPSIS=VISION]

 Biopsy is the removal of the tissue from the living

organism for the purpose of histopathological
examination and diagnosis.

 A biopsy is the examination of tissue removed from a

lesion and by extension the term is also used to convey
the removal of the tissue.[WHO 1966]
 • To confirm a clinical impression of a lesion.
 • When an inflammatory lesion is not responding to
conservative therapy after 10 to 14 days.
 • For the determination of the more definitive treatment of
the lesion
 • To determine the nature of any intraosseous lesion which
cannot be identified clinically and radiographically.
 • To determine the nature of all abnormal tissue removed
from the oral cavity, including cysts and granulomas.
Excisional Biopsy

 An excisional biopsy implies to the complete removal of the

lesion for microscopic study.

 Technique: The entire lesion with 2 to 3mm of normal

appearing tissue surrounding the lesion is excised if benign.
 ADVANTAGE
Both diagnostic and therapeutic Need not perform
separate surgery.
 INDICATIONS –
Should be employed with small lesions. Less
than 2cm – The lesion on clinical exam appears
benign. – When complete excision with a margin of
normal tissue is possible without mutilation.
 CONTRAINDICATION –
In large lesion >2cm
Incisional Biopsy
 Removal of just a small part of the lesion for
histopathological study.
 An incisional biopsy implies the acquisition and presentation
of a representative part of a lesion

Indications:
– Lesion larger than 2 cm.
– Dangerous location of the lesion (nerves, vessels)
– Great suspicion of malignancy
 Technique:
 – Representative areas are biopsied in a wedge fashion.
 – Margins should extend into normal tissue on the deep
surface.
 – Necrotic tissue should be avoided.
 – A narrow deep specimen is better than a broad shallow one
– Sharp blade
 – Do not inject L.A
NEEDLE BIOPSIES
 Are performed to sample suspicious masses that are easily
accessible, such as some growths in the breasts, thyroid,
lungs, liver, and kidneys.
 fast relatively inexpensive, and easy to perform and usually re
quire only local anesthesia.
 NEEDLE CORE BIOPSY- uses a specially designed needle to
obtain a small core of tissue. Most often the specimen is
sufficient to permit accurate diagnosis
B. Surgery as a primary treatment

a) Local incision
b) Wide or radial excision
c) Video assisted endoscopic surgery
d) Salvage surgery
e) Modified radial mastectomy
f) Electro surgery cryosurgery
g) Chemosurgery
h) Laser surgery
i) Stereotactic radiosurgery
SURGERY AS PRIMARY TREATMENT-
 goal is to remove the entire tumor or as much as is feasible (a
procedure sometimes called DEBULKING) and any involved
surrounding tissue, including regional lymph nodes
LOCAL EXCISIONS-
 warranted when the mass is small. Includes removal of the
mass and a small margin of normal tissue that is easily
accessible.
WIDE/RADICAL
EXCISIONS(en bloc dissections)-
 include removal of the primary tumor, lymph nodes, adjacent
involved structures, and surrounding tissue that may be at
high risk for tumor spread.
 -this surgical method can result in disfigurement and altered
functioning.
 -considered if the tumor can be removed completely and the
chances of cure or control are good.
SALVAGE (RESCUE)SURGERY-
 is an additional treatment option that uses an extensive
surgical approach to treat the local recurrence of the
cancer after a less extensive primary approach is used.
 Has used to refer to surgical treatment after failure of initial
treatment in various scenarios including treatment of delayed
neck metastasis, recurrent primary tumors or even
metastasis
Modified radial mastectomy
 Is a procedure which the entire breast is removed, incuding
the skin, areola, nipple and the most axillary lymph nodes:
 It is the primary method of treatment of breast

HOW LONG DOES THE MODIFIED RADICAL

MASTECTOMY TAKE?
RADICAL MASTECTOMY
 Is a surgical procedure involving the removal of breast
underlying chest muscle (including pectoralis major and
pectoralis minor), and lymph nodes of the axilla as a
treatment of breast cancer

COMPLICATION OF RADIAL MASTECTOMY

SIDE EFFECTS OF MASTECTOMY

 ELECTROSURGERY- makes use of electrical
current to destroy the tumor cells.
 -is the application of a high frequency
alternating polarity, electrical current to
biological tissue as to cut, fulgurate tissue
 Is a term used to describe multiple modalities
that use electricity to cause thermal destrucyion
of tissue dehydration or vaporization
CRYOSURGERY- uses
liquid nitrogen to freeze
tissue to cause
cell destruction
Chemosurgery

 Chemical removal of disease or unwanted

tissue
 Excision od disease tissue after it has been
fixed in site
LASER SURGERY-
makes use of light and energy
aimed at an exact tissue location
and depth to vaporize cancer
cells.
STEREOSTATIC SURGERY-
 is a single and highly precise administration of high-dose
radiation therapy used in some types of brain and head and
neck cancers.This type of radiation has such a dramatic effect
on the target area that the changes are considered to be
comparable to more traditional surgical approaches.