Inserting ex vivo Fluorescence Confocal Microscopy Perioperatively in Mohs Micrographic Surgery Expedites Bedside Assessment of Excision Margins in Recurrent Basal Cell Carcinoma

Abstract

Mohs micrographic surgery can be employed in recurrent basal cell carcinoma, although it is a time-consuming technique. Recently, ex vivo fluorescence confocal microscopy (FCM) has been employed to obtain a fast assessment of tumor margins at the bedside. In our case we successfully employed ex vivo FCM to assess the tumor margins and we treated the persistent tumor with intensity-modulated radiation therapy. Our case demonstrates that a multidisciplinary approach is very efficient in managing complex and recurrent tumors and highlights the benefits of FCM as a new technique that can be used in the surgical theater to speed up the entire procedure.

Evaluation of breast tissue with confocal strip-mosaicking microscopy: a test approach emulating pathology-like examination

“…In dermatological settings, for example, confocal mosaicking technology is being implemented for the detection of residual basal cell carcinoma margins to guide Mohs surgery of skin. [20][21][22][23] Dobbs et al 7 conducted an initial study to evaluate the usefulness of confocal microscopy for breast specimens. In this study, the mosaics (composite confocal images) were compared to the hematoxylin and eosin (H&E)-stained sections, and single images of ROIs in size 750 × 750 μm 2 were extracted for evaluation by the reader (pathologist).…”

Evaluating ex vivo fluorescence confocal microscopy images of basal cell carcinomas in M ohs excised tissue

“…[10][11][12] Among them, acridine orange is a well-known contrast agent that specifically stains nuclei and increases the contrast between the nuclear morphology and the surrounding background dermis. [16][17][18][19][20] Reported imaging time is now less than 3 min, based on technological advances in optics, electronics and mechanics. Because these images are digitally acquired, it is also possible to zoom in and zoom out to observe tissue with different magnifications, similar to the changing of magnifications when examining frozen sections for histopathology.…”

Basal cell carcinoma: the utility of in vivo and ex vivo confocal microscopy

“…[32][33][34][35][36][37][38][39][40][41][42][43][44] Basically, FCM criteria include the presence of: (i) Fluorescence. [32][33][34][35][36][37][38][39][40][41][42][43][44] Basically, FCM criteria include the presence of: (i) Fluorescence.…”