To investigate current surgical margin assessment strategies, intraoperative frozen section (FS) use, and the interpretation of dysplasia and carcinoma in situ (CIS) among European academic head and neck surgeons.

A cross-sectional, web-based survey was distributed to head and neck surgeons in 17 European countries between June 5 and July 10, 2025. The 20-item questionnaire, structured into four domains, examined FS use, margin definitions, pathology access, and intraoperative imaging. Descriptive analysis was applied.

Most respondents (92.3%) routinely used FS during oral cavity resections. Tumor bed sampling was preferred over main specimen sampling (64.1% vs. 35.8%), mainly to reduce sampling error (40.1%) and based on clinical experience (36.7%). A ≥ 5 mm cutoff was the most accepted threshold for negativity (77.7%). CIS was considered a positive margin by 88% of participants, while interpretation of dysplasia varied. Only 42.7% reported access to a dedicated head and neck pathologist. Despite this, 94.8% expressed willingness to adopt intraoperative imaging modalities if proven effective.

This multi-country European survey among predominantly academic head and neck surgeons highlights both consensus and variability in surgical margin assessment. While FS remains widely practiced, significant differences persist in interpreting dysplasia and FS-guided margin conversion. These findings stress the need for standardized guidelines. Future prospective studies should validate margin thresholds and investigate the value of emerging intraoperative imaging technologies to improve oncologic outcomes.