Microscopically controlled surgery (MCS)

“…These new techniques help to support clinical discrimination of tumour borders and invasion depth before dermatosurgery [2] . Therefore, the invasion depth through the dermal-epidermal junction zone, as well as the lateral margins of the tumour, must be assessed.…”

Section: Discussionmentioning

confidence: 99%

“…According to standardised dermatohistological procedures, all excised tumours were immediately fi xed in formalin postoperatively and subsequently processed in serial sections including " T ü binger Torte " (muffi n preparation) [2,12] in order to confi rm a complete removal of the tumour. After formalin fi xation for 24 h, the samples were embedded in paraffi n and 3 μ m sections were prepared and stained with HE (Fisher Scientifi c GmbH, Dreieich, Germany).…”

Section: Preparation Of Samplesmentioning

confidence: 99%

“…However, dermatohistopathology is limited by both the time required for a standardised preparation of the specimen and the additional immunohistological staining in order to diagnose the tumour and evaluate its lateral borders and invasion depth suffi ciently (3D histology) [1,2] . Two promising, recently developed diagnostic techniques, the confocal laser microscopy (LSM) [3,4] and the two-photon microscopy (TPM) [5,6] , both of which focus on a non-invasive " biopsy-free " diagnosis of cutaneous diseases, are not yet in the clinical routine, but in clinical and experimental settings under investigation.…”

Section: Introductionmentioning

confidence: 99%

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High-resolution two-photon imaging of HE-stained samples in dermatohistopathology – A pilot study on skin tumours

Göppner¹,

Mechow²,

Liebscher³

et al. 2012

Photonics &Amp; Lasers in Medicine

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Non-invasive two-photon microscopy (TPM) provides a new technique which could become in the future a substitute for hematoxylin and eosin (HE) staining of tissue sections of the epidermis and upper and middle dermis as well. High-resolution imaging, in combination with false-colour representation, allows an accurate reproduction of standard microscopy. The vertical skin viewing of epidermis and upper dermis by means of TPM allows for a new histopathological supportive technique, especially in non-melanoma skin cancer such as squamous cell carcinoma and basal cell carcinoma. If it could be used on fresh tissue samples, it could provide an alternative method to Mohs 3D histology, even though the defi nitive criteria for melanocytic tumours have not yet been suffi ciently evaluated.Keywords: basal cell carcinoma; dermatohistopathology; ex-vivo imaging; false-colour representation; malignant melanoma; non-melanoma skin cancer; squamous cell carcinoma; two-photon microscopy; zoom function. ZusammenfassungDie neue, nicht-invasive Zwei-Photonen-Mikroskopie (twophoton microscopy, TPM) erm ö glicht eine qualitativ hohe Reproduktion fast gleichwertig zu histologischen Präparaten exzidierter Tumoren, die die Epidermis und obere und mitt lere Dermis erfassen. Mit Hilfe der durch die ScannerTechnik erzeugten hochaufgel ö sten Bilder in Kombination mit einer zus ä tzlichen Falschfarbendarstellung k ö nnen relevante diagnostische wie prognostische Kriterien akkurat beurteilt werden. Die vertikale Bildgebung von Dermis und Epidermis durch die TPM erm ö glicht eine erg ä nzende histopathologische Beurteilung vor allem bei wei ß em Hautkrebs wie dem Plattenepithel-oder Basalzellkarzinom. Ihr zuk ü nftiger Einsatz an Frischpr ä paraten verspricht daher eine Alternative zu Mohs 3D-Histologie zu sein, auch wenn entscheidende Diagnosekriterien bei melanozyt ä ren Tumoren bislang noch nicht hinreichend beurteilbar sind.Schl ü sselw ö rter: Zwei-Photonen-Mikroskopie; Ex-vivo-Bildgebung; Ü bersicht-und Detailaufnahmen; Falschfarbendarstellung; Dermatohistologie; Plattenepithelkarzinom; Basalzellkarzinom; wei ß er Hautkrebs; malignes Melanom.

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Operative Therapie von akral lokalisierten Melanomen

Möhrle¹,

Lichte²,

Breuninger³

2011

Hautarzt

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Acral lentiginous melanomas (ALM) represent 4-10% of cutaneous melanomas in white populations. Patients with ALM seem to have a poor prognosis, often due to late diagnosis. Micrographic surgery (3D-histology) is not seen as surgical procedure but more as histopathological technique. With micrographic surgery, continuously spreading ALM can be excised with smaller excision margins and good functional and cosmetic outcomes. In a recent study, 244 patients with ALM were compared using conventional histology versus 3D-histology. Clinical and surgical risk factors influence the prognosis of ALM. Tumor thickness and ulceration are the most important prognostic factors. 3D-histology with paraffin technique (optionally combined with immunohistological methods) can reduce excision margins and avoid local recurrences. Subungual melanomas represent only 2-3% of cutaneous melanomas in Caucasian and 20% in African or Asian skin type and are often clinically misdiagnosed. They are often localized on the thumb or great toe, which are most important for the function of the affected limb. The excision of subungual melanoma with 3D-histology and tumor-free excision margins including the nail matrix can be seen as a safe surgical strategy, which does not hazard the prognosis of the patient. Function and cosmesis of the finger or toe are preserved. Amputation in subungual melanoma is not recommended and should be reserved only for infiltrating melanomas with affection of the bone or joint.

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Microscopically controlled surgery (MCS)

Abstract: To confirm a local R0 resection of tumors with infiltrative growth at problem sites and for sparing of tissue, microscopically controlled surgery represents a safe and proven method, particularly when there are no gaps between the tissue taken at the incision margins.

Cited by 31 publications

References 32 publications

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

High-resolution two-photon imaging of HE-stained samples in dermatohistopathology – A pilot study on skin tumours

Operative Therapie von akral lokalisierten Melanomen

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