Ex vivo fluorescence confocal microscopy for fast evaluation of tumour margins during Mohs surgery

Abstract

The results demonstrate the feasibility of confocal mosaicing microscopy in fresh tissue for rapid surgical pathology, potentially to expedite and guide Mohs surgery with high accuracy. This observation is an important step towards the goal of using real-time surgical pathology for skin tumours.

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

“…Their result 30 is on par with and validates the results of the initial studies. 34 Micronodular/infiltrating BCC was the main histological subtype in this study.…”

“…Recently, Bennàssar et al 30 conducted another study, in the Mohs surgical setting, where-for the first time-true surgically excised fresh tissue margins from 80 BCC lesions (with or without tumors) were prospectively imaged with FCM. The goals of this study were (a) to evaluate the sensitivity and specificity of ex vivo FCM imaging in detecting residual BCC in Mohs tissue excisions and (b) to calculate the time invested up to the diagnosis for both FCM and frozen sections.…”

“…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.…”

Ex vivo fluorescence confocal microscopy in conjunction with Mohs micrographic surgery for cutaneous squamous cell carcinoma

“…FCM images offer nuclear-level resolution-similar to histopathologyand FCM does so in just a few minutes. [1][2][3][4][5] The microscope is commonly used in fluorescent mode with acridine orange, a contrast agent that specifically stains DNA and RNA and increases the contrast between the nuclear morphology and the surrounding background.…”

Skin surgery, an evidence-based update: meeting report

“…14 During MMS, RCM has been used to evaluate resection margins. 15,16 Analysis takes only 3 min, but with a sensitivity of 88% and specificity 99% in detecting BCC, 16 Professor Harwood presented a trial proposal for the surgical management of high-risk SCCs. With little or predominantly poor-quality literature and few trials in progress, a clinician survey for the National Institute for Health Research programme grant 'setting priorities and decreasing uncertainties' identified SCC management as a research priority.…”