Confocal Examination of Untreated Fresh Specimens From Basal Cell Carcinoma

Gerger, Armin; Horn, Michael; Koller, Sílvia Helena; Weger, Wolfgang; Massone, Cesare; Leinweber, Bernd; Kerl, Helmut; Smolle, Josef

doi:10.1001/archderm.141.10.1269

Cited by 29 publications

(22 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent study reported high diagnostic accuracy of 100% for detection of BCCs (Gerger et al , 2005). A later study (Horn et al , 2007) on squamous cell carcinomas from 20 patients yielded sensitivity of 95% and specificity of 96%.…”

Section: Discussionmentioning

confidence: 99%

Confocal mosaicing microscopy in skin excisions: a demonstration of rapid surgical pathology

Gareau

Patel

et al. 2009

Journal of Microscopy

103

View full text Add to dashboard Cite

SummaryPrecise micro-surgical removal of tumour with minimal damage to the surrounding normal tissue requires a series of excisions, each guided by an examination of frozen histology of the previous. An example is Mohs surgery for the removal of basal cell carcinomas (BCCs) in skin. The preparation of frozen histology is labour-intensive and slow. Confocal microscopy may enable rapid detection of tumours directly in surgical excisions with minimal need for frozen histology. Mosaicing of images enables observation of nuclear and cellular morphology in large areas of surgically excised tissue. In skin, the use of 10-1% acetic acid as a reflectance contrast agent brightens nuclei in 0.5-5 min and enhances nuclear-to-dermis contrast and detectability of BCCs. A tissue fixture was engineered for precisely mounting surgical excisions to enable mosaicing of 36 × 36 images to create a field of view of 12 × 12 mm. This large field of view displays the excision at 2× magnification, similar to that routinely used by Mohs surgeons when examining frozen histology. Comparison of mosaics to histology demonstrates detectability of BCCs. Confocal mosaicing presently requires 9 min, instead of 20-45 min per excision for preparing frozen histology, and thus may provide a means for rapid pathology-at-the-bedside to expedite and guide surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Confocal mosaicing microscopy in skin excisions: a demonstration of rapid surgical pathology

Gareau

Patel

et al. 2009

Journal of Microscopy

103

View full text Add to dashboard Cite

show abstract

“…[15] It can image the epidermis and dermis with cellular-level resolution (0.5–1 μm in lateral dimension and 4–5 μm in axial ones) to a depth of 500 μm, producing images representing horizontal planes of the skin. It employs a diode laser at 830 nm with a power, less than 35 mW.…”

Section: Other Diagnostic Techniques For Skin Tumoursmentioning

confidence: 99%

Skin tumours

Khandpur¹,

Ramam²

2012

J Cutan Aesthet Surg

View full text Add to dashboard Cite

“…Later studies that were conducted on larger sample sizes using RCM-acetic acid approach also reported similar limitations. 27 Therefore, RCM-acetic acid methodology was, subsequently, replaced by FCM imaging again using specific nuclear contrast agents but in fluorescence, such as acridine orange, methylene blue, and toluidine blue; 13,14 methylene blue and toluidine blue primarily stain nucleic acid (DNA and RNA) and are frequently used as conventional histology stains. 13 Acridine orange interacts with the DNA and RNA of the nuclei, without staining collagen tissue.…”

Section: Development Of Confocal Mosaicking Microscopy Imaging Protocmentioning

confidence: 99%

“…25,26 Confocal mosaicking microscopy (CMM) is currently the furthest advanced, being implemented and validated in Mohs surgical settings in real time. [27][28][29][30][31] In these settings, CMM is being integrated into the clinical workflow and has shown high sensitivity and specificity for detecting residual BCC tumors in fresh Mohs surgical excisions. In this article, we assess the progress of CMM-guided Mohs surgery from bench-top development in a laboratory to actual bedside implementation in Mohs surgical settings.…”

Section: Introductionmentioning

confidence: 99%

Implementation of fluorescence confocal mosaicking microscopy by “early adopter” Mohs surgeons and dermatologists: recent progress

2017

View full text Add to dashboard Cite

Manu Jain, Milind Rajadhyaksha, Kishwer Nehal, "Implementation of fluorescence confocal mosaicking microscopy by "early adopter" Mohs surgeons and dermatologists: recent progress," J. Abstract. Confocal mosaicking microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed in fluorescence mode using acridine orange (nuclear specific dye), it enhances nuclei-to-dermis contrast that enables detection of all types of basal cell carcinomas (BCCs), including micronodular and thin strands of infiltrative types. So far, this technique has been mostly validated in research settings for the detection of residual BCC tumor margins with high sensitivity of 89% to 96% and specificity of 99% to 89%. Recently, CMM has advanced to implementation and testing in clinical settings by "early adopter" Mohs surgeons, as an adjunct to frozen section during Mohs surgery. We summarize the development of CMM guided imaging of ex vivo skin tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of residual BCC margins in the Mohs surgical setting but also for some melanocytic lesions and other skin conditions in clinical dermatology settings. Last, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.

show abstract

Confocal Examination of Untreated Fresh Specimens From Basal Cell Carcinoma

Cited by 29 publications

References 12 publications

Confocal mosaicing microscopy in skin excisions: a demonstration of rapid surgical pathology

Confocal mosaicing microscopy in skin excisions: a demonstration of rapid surgical pathology

Skin tumours

Implementation of fluorescence confocal mosaicking microscopy by “early adopter” Mohs surgeons and dermatologists: recent progress

Contact Info

Product

Resources

About