To compare ex vivo confocal laser scanning microscopy (CLSM), which offers rapid images without the need for tissue processing, vs 3-dimensional histologic imaging, the criterion standard treatment for basal cell carcinomas in high-risk areas of the face.Design: Single-center prospective trial.Setting: Dermatosurgical unit of a university hospital.Patients: Seventy-two consecutive surgically removed basal cell carcinomas were examined using CLSM vs standard paraffin-embedded 3-dimensional histologic imaging.Interventions: A total of 312 images, including 73 midsections, 196 lateral margins, 23 "muffins," and 20 "bread loaf sections," were obtained using CLSM. Immediately after surgery, the CLSM images were evaluated by the surgeon. The following day, the 3-dimensional histologic slides were evaluated and compared with the CLSM images.Main Outcome Measures: Diagnostic accuracy of ex vivo CLSM to detect tumor strands of basal cell carcinomas and the practicality of using CLSM vs 3-dimensional histologic slides in micrographic surgery.Results: The sensitivity of CLSM reached 94.0% in midsections, 73.7% in lateral margins, 80.0% in muffins, and 80.0% in bread loaf sections. The CLSM images were evaluated by the surgeon within 7.5 minutes.Conclusions: Confocal laser scanning microscopy lacks high sensitivity to detect small tumor strands of basal cell carcinomas. In the future, CLSM may represent a timesaving and less expensive alternative to cryostat histopathologic examination.
vertical mattress suture, as described by Zitelli and Moy, 3 is centrally placed and then repeated immediately adjacent, thus passing through each wound edge twice before tying (Fig. 1f). The mechanical advantage of two buried vertical mattress sutures in continuity, permits effortless closure of the central portion of the ellipse and the increased friction caused by the suture material prevents the suture slipping prior to the locking knot being thrown. Our technique is equally of benefit in smaller defects under tension and differs from a 'delayed-tying technique' 4 in that the two side-by-side sutures (each placed slightly off centre in a small defect, one above and one below) are in continuity. Hence a wound is closed with a single knot tied in the usual fashion while providing the benefits of two rather than one buried suture.Elliptical excisional surgery is the cornerstone of dermatological surgical practice. The pearls for practice we present do not add to the cost of the procedure and in our experience optimize outcomes for elliptical excision.
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