Immunofluorescent and immunoperoxidase staining of antibodies to fibrous keratin. Improved sensitivity for detecting epidermal cancer cells

Abstract

Microscopically controlled surgery (Mohs' surgery) is a widely accepted technique because it provides total extirpation of skin tumors with maximum conservation of tissue. However, in poorly differentiated tumors it is often difficult microscopically to recognize individual tumor cells in the midst of an inflammatory cell infiltrate, in fibrotic tissue, in connective tissue around blood vessels, in nerve sheaths, and in fascial planes. We have developed techniques to differentiate tumor cells, derived from the epidermis, from the normal nonkeratinizing tissue of mesodermal origin or the inflammatory cell infiltrate. In frozen sections, indirect immunofluorescence techniques with polyclonal antibodies to fibrous keratin allowed rapid identification of tumor cells of basal and squamous cell carcinoma. Immunoperoxidase staining proved to be a remarkably sensitive method for the identification of such carcinoma cells in both frozen and paraffin-embedded sections. When used in combination with the precise mapping techniques of Mohs' surgery, these reliable and specific stains permitted greater accuracy in assessing the total resection of an invasive tumor.

Rapid Immunostaining in Mohs: Current Applications and Attitudes

“…The early publications in the 1980s and 1990s, introduced the fundamentals of IHC staining in Mohs for NMSC. 1,2,7 In years to come, the focus of publications shifted to an emphasis on diversification and time efficient protocol, as well as analysis of the reliability of IHC stains. In our survey, responses pertaining to 'years of fellowship training' were grouped.…”

“…The literature about rapid immunostaining in Mohs has been increasing over the last three decades and the content of those publications has exhibited certain trends. The early publications in the 1980s and 1990s, introduced the fundamentals of IHC staining in Mohs for NMSC . In years to come, the focus of publications shifted to an emphasis on diversification and time efficient protocol, as well as analysis of the reliability of IHC stains.…”

“…The first published application for immunohistochemical (IHC) stains in Mohs revealed their utility in unmasking squamous cell and basal cell carcinomas, thereby enhancing the sensitivity of micrographic surgery. 1 Publications that followed would reiterate that tumor identification could be made easier through the use of rapid cytokeratin stains. 2 Eventually, the applications for immunostains began to increase in number and diversify.…”

“…Rapid immunostaining in Mohs micrographic surgery (MMS) has been evolving since the early 1980s. The first published application for immunohistochemical (IHC) stains in Mohs revealed their utility in unmasking squamous cell and basal cell carcinomas, thereby enhancing the sensitivity of micrographic surgery . Publications that followed would reiterate that tumor identification could be made easier through the use of rapid cytokeratin stains .…”

Use of a novel 1-hour protocol for rapid frozen section immunocytochemistry, in a case of squamous cell carcinoma treated with Mohs micrographic surgery

“…We propose using the pancytokeratin markers AE1/ AE3, which have an affinity for heavy and low molecular weight cytokeratins. 4 Although precise sensitivity and specificity data have not been reported for these markers, the literature points towards the AE1/AE3 combination being a sensitive and probably the best marker for SCCs, whatever the tumour site. 5 Using AE1/AE3 allows the patient's own epidermis to act as the internal control in this context, 5 but uptake by atypical squamous cells would also be expected.…”