Tumor Detection After Inflammation or Fibrosis on Mohs Levels

Macdonald, Jillian; Sneath, Jason R.; Cowan, Bryce J.; Zloty, David

doi:10.1111/dsu.12012

Cited by 14 publications

(8 citation statements)

References 4 publications

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“…who had been trained at different centers. In addition, the proportion of cases found to have dense inflammation preceding tumor was 2% (60 of 3148 cases), which was very similar to the 1.9% of cases in which Macdonald et al 4 reported in the detection of additional tumor when inflammation prompted another Mohs stage excision. Notably, this 2% statistic represented only the 60 medical records among the 3148 reviewed in the present study in which dense inflammation without tumor in one stage was followed by visible tumor in the next stage.…”

Section: Discussionsupporting

confidence: 72%

“…1 Dense inflammation cannot only camouflage a tumor but can also be a harbinger of more tumor beyond the margin of a specimen. Prior work [2][3][4] established this predictive utility of inflammation. Approximately one-fourth of a series of 22 419 consecutive cases revealed sufficient inflammation and fibrosis to warrant harvesting of an additional Mohs stage, with 1.9% of the latter detecting skin cancer.…”

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confidence: 96%

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Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer

et al. 2016

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IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed on May 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For each wedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05). The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82% to 96%. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

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Section: Discussionsupporting

confidence: 72%

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confidence: 96%

Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer

et al. 2016

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“…In a review of more than 22,000 cases, the presence of inflammation and fibrosis led to excision of additional tissue in 28% of cases. However, histology confirmed the presence of additional tumour only in only 1.9% of these tissue layers [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Boitor

Wolf

Weesie

et al. 2021

Biomed. Opt. Express

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We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis “tumour clear yes/no” during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting.

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“…There might be several explanations for this finding; firstly, the analyses might be affected by multicollinearity between recurrent BCC and having received previous treatment. Secondly, the local practise at our department during MMS is to remove all fibrotic tissue, even if there is no visible tumour (due to the possible tumour growth beneath the fibrosis in incompletely excised BCC) in the removed specimen 20 . This procedure might lead to an increased number of stages in the incompletely excised but not clinically recurrent BCC.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the local practise at our department during MMS is to remove all fibrotic tissue, even if there is no visible tumour (due to the possible tumour growth beneath the fibrosis in incompletely excised BCC) in the removed specimen. 20 This procedure might lead to an increased number of stages in the incompletely excised but not clinically recurrent BCC. However, the results might also indicate that previously received treatment is a more important risk factor for complicated surgery than having had a diagnosed recurrence.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for complicated Mohs surgery in the South Sweden Mohs Cohort

Nätterdahl

Kappelin

Persson

et al. 2022

Acad Dermatol Venereol

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Background Mohs micrographic surgery (MMS) is a precise, tissue-sparing surgical technique that offers superior cure rates compared to traditional surgical excision. However, the degree of difficulty of MMS depends on many variables, and consequently, the number of surgical stages required for each case is quite unpredictable.Objectives To identify risk factors for complicated MMS, defined as MMS requiring ≥3 stages.Methods In a cohort study design, data were prospectively collected from 612 patients that underwent MMS for basal cell carcinoma (BCC) at the

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Tumor Detection After Inflammation or Fibrosis on Mohs Levels

Abstract: Taking an additional Mohs level when dense inflammation or fibrosis is present may be warranted to ensure complete tumor removal.

Cited by 14 publications

References 4 publications

Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer

Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Risk factors for complicated Mohs surgery in the South Sweden Mohs Cohort

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