Use of Ex Vivo Confocal Scanning Laser Microscopy during Mohs Surgery for Nonmelanoma Skin Cancers

Chung, Vinh Q.; Dwyer, Peter; Nehal, Kishwer S.; Rajadhyaksha, Milind; Menaker, Gregg M.; Charles, Carlos A.; Jiang, S. Brian

doi:10.1111/j.1524-4725.2004.30505.x

Cited by 84 publications

(104 citation statements)

References 15 publications

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“…This potential was recognized more than 10 years ago. Since then there have been numerous attempts to use this technology as an aid in diagnostics [1][2][3] and treatment guidance [4][5][6][7] of skin cancers. Endogenous (melanin [8][9][10]) and exogenous (aluminum chloride [4] and acetic acid [5]) contrast agents provide strong contrast in scattering, thus facilitating the process of detecting pathology.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers

2007

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The morphological features and appearance of skin structures in the fluorescence images correlate well with corresponding histology for all investigated tumor-types. Multi-spectral reflectance images provide information on the tissue spectral responses and are complimentary to the fluorescence images. The differences detected by fluorescence polarization in cancerous and normal structures may be used for cancerous tissue discrimination. Our results indicate the feasibility of using multimodal confocal microscopy as real-time tool for detecting skin pathology.

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Section: Introductionmentioning

confidence: 99%

“…Currently, extensive training is required for the reliable interpretation of confocal images. In addition, several reports indicate that small tumor foci are not consistently identified [7]. Therefore, the questions of the sensitivity and specificity, provided by confocal imaging should also be addressed.…”

Section: Introductionmentioning

confidence: 99%

Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers

2007

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“…The design and instrumentation details for this microscope were reported previously. 8,9,12 The illumination wavelength is 830 nm from a diode laser, with an illumination power of less than 16 mW at the tissue level. An ϫ30 magnifying water immersion objective lens (Lucid Stable View, Lucid Inc) with a 0.9 numerical aperture was used, providing a field of view of 0.5ϫ0.5 mm 2 .…”

Section: Confocal Laser Scanning Microscopymentioning

confidence: 99%

Confocal Laser Scanning Microscopy vs 3-Dimensional Histologic Imaging in Basal Cell Carcinoma

Ziefle

Schüle²,

Breuninger³

et al. 2010

Arch Dermatol

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To compare ex vivo confocal laser scanning microscopy (CLSM), which offers rapid images without the need for tissue processing, vs 3-dimensional histologic imaging, the criterion standard treatment for basal cell carcinomas in high-risk areas of the face.Design: Single-center prospective trial.Setting: Dermatosurgical unit of a university hospital.Patients: Seventy-two consecutive surgically removed basal cell carcinomas were examined using CLSM vs standard paraffin-embedded 3-dimensional histologic imaging.Interventions: A total of 312 images, including 73 midsections, 196 lateral margins, 23 "muffins," and 20 "bread loaf sections," were obtained using CLSM. Immediately after surgery, the CLSM images were evaluated by the surgeon. The following day, the 3-dimensional histologic slides were evaluated and compared with the CLSM images.Main Outcome Measures: Diagnostic accuracy of ex vivo CLSM to detect tumor strands of basal cell carcinomas and the practicality of using CLSM vs 3-dimensional histologic slides in micrographic surgery.Results: The sensitivity of CLSM reached 94.0% in midsections, 73.7% in lateral margins, 80.0% in muffins, and 80.0% in bread loaf sections. The CLSM images were evaluated by the surgeon within 7.5 minutes.Conclusions: Confocal laser scanning microscopy lacks high sensitivity to detect small tumor strands of basal cell carcinomas. In the future, CLSM may represent a timesaving and less expensive alternative to cryostat histopathologic examination.

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“…In this way, blood was also removed. The tissue, oriented on the cut side, was placed onto the microscope and digital mosaics were acquired as described elsewhere [3,4]. The time needed to acquire all samples was about 9 min.…”

Section: Case Reportmentioning

confidence: 99%

“…Recently, ex vivo fluorescence confocal microscopy (FCM) has been employed as an innovative tool that can provide a fast imaging of the fresh tissue with no need of any staining or special sample preparation that may require a dedicated laboratory technician [3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Compared to in vivo confocal microscopy, FCM permits the analysis of freshly excised tumor allowing the assessment of deep margins with higher resolution because of the employment of fluorescent agent contrast.…”

Section: Introductionmentioning

confidence: 99%

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

Longo¹,

Ragazzi²,

Castagnetti³

et al. 2013

Dermatology

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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.

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Use of Ex Vivo Confocal Scanning Laser Microscopy during Mohs Surgery for Nonmelanoma Skin Cancers

Cited by 84 publications

References 15 publications

Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers

Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers

Confocal Laser Scanning Microscopy vs 3-Dimensional Histologic Imaging in Basal Cell Carcinoma

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

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