What is Complete Circumferential Peripheral and Deep Margin Assessment (CCPDMA)?

CCPDMA is an advanced surgical treatment used to remove non-melanoma skin cancers, like basal cell carcinoma and squamous cell carcinoma. CCPDMA is designed to provide the highest cure rate of any form of skin cancer removal and at the same time limit the loss of unaffected (normal) tissue. It is for this reason that CCPDMA is most suitable for skin cancers on the head and neck, where limiting the removal of normal tissue on critical facial areas (eyelids, nose, forehead, cheeks, ears, and lips) greatly improves the final aesthetic and functional outcome by limiting scarring and permanent disfigurement.


Tumour cells often extend beyond the visible tumour – these tumour cells are not visible to the naked eye. However, CCPDMA includes immediate examination of the resected (surgically removed) tissue with microscopic analysis allowing the surgeon to track the removal of the cancer and ensure the complete elimination of all tumour. Cure rates for CCPDMA are close to 99% for most primary (untreated) cancers with a slightly lower cure rate for secondary or recurrent (previously treated) cancers. This cutting-edge treatment requires expertise in surgery, pathology and reconstructive surgery. There is a Pathologist with the team during the surgery

What does CCDPMA Surgery involve?

This procedure relies on the following highly specialized and controlled sequence of surgical tumour resection and pathological analysis:


  • A 1-2 mm boundary is marked beyond the visible tumour
  • The tumour is injected with local anaesthetic
  • The marked tissue is surgically removed (1st level) and it and the patient are marked with reference points
  • Tissue specimens are then labeled with dyes that allow the surgeon and pathologist to reference the tissue seen on microscopic slides directly back to the patient using the reference points
  • Technicians in the surgical suite produce frozen section slides of the removed tissue for microscopic analysis
  • If tumour is demonstrated in the margin (edge) of the resection tissue, the surgeon assumes that tumour remains in the patient and an additional tissue level is resected. This process continues until the microscopic analysis confirms complete tumour resection and the patient is tumour free
  • Now reconstruction of the surgical defect is planned

What should I expect?

You should expect the highest possible cure rate for your skin cancer of any treatment method offered anywhere in the world. Second, you should expect the sacrifice of the least amount of uninvolved tissue possible.


Patients undergoing CCPDMA are often surprised by:


  • The duration of treatment
    Surgical resection of one ‘level’ of tissue and the ensuing preparation and analysis of microscopic slides take approximately 60-75 minutes. If 2 to 3 levels are required this easily translates into 3 hours excluding the reconstruction.
  • The size of the surgical defect
    As previously stated, CCPDMA provides the surgeon with the ability to identify cancer cells beyond the visible tumour. It is for this reason the CCPDMA resection of a skin cancer most often proceeds past where either the surgeon or the patient anticipated when they examined the cancer pre-operatively with the naked eye. It is also for this precise reason that the CCPDMA method provides the patient with the highest possible cure rate for skin cancer.

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