Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology

Milind Rajadhyaksha, Gregg Menaker, Thomas J Flotte, Peter J. Dwyer, Salvador González

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Precise removal of nonmelanoma cancers with minimum damage to the surrounding normal skin is guided by the histopathologic examination of each excision during Mohs micrographic surgery. The preparation of frozen histopathology sections typically requires 20-45 min per excision. Real-time confocal reflectance microscopy offers an imaging method potentially to avoid frozen histopathology and prepare noninvasive (optical) sections within 5 min. Skin excisions (≈ 1 mm thick) from Mohs surgeries were washed with 5% acetic acid and imaged with a confocal cross-polarized microscope. The confocal images were compared with the corresponding histopathology. Acetic acid causes compaction of chromatin that increases light back-scatter and makes the nuclei bright and easily detectable. Crossed-polarization strongly enhances the contrast of the nuclei because the compacted chromatin depolarizes the illumination light whereas the surrounding cytoplasm and normal dermis does not. Fast low-resolution examination of cancer lobules in wide fields of view followed by high-resolution inspection of nuclear morphology in small fields of view is possible; this is similar to the procedure for examining histopathology sections. Both the Mohs surgeon and the patient will potentially save several hours per day in the operating room. Fast confocal reflectance microscopic examination of excisions (of any thickness) may improve the management of surgical pathology and guide microsurgery of any human tissue.

Original languageEnglish (US)
Pages (from-to)1137-1143
Number of pages7
JournalJournal of Investigative Dermatology
Volume117
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Mohs Surgery
Acetic Acid
Surgery
Chromatin
Skin
Microscopic examination
Operating rooms
Light
Surgical Pathology
Microsurgery
Frozen Sections
Pathology
Operating Rooms
Dermis
Lighting
Confocal Microscopy
Neoplasms
Cytoplasm
Compaction
Microscopes

Keywords

  • Dermatology
  • Lasers
  • Optical imaging
  • Optical microscopy
  • Scanning
  • Surgical pathology

ASJC Scopus subject areas

  • Dermatology

Cite this

Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology. / Rajadhyaksha, Milind; Menaker, Gregg; Flotte, Thomas J; Dwyer, Peter J.; González, Salvador.

In: Journal of Investigative Dermatology, Vol. 117, No. 5, 2001, p. 1137-1143.

Research output: Contribution to journalArticle

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abstract = "Precise removal of nonmelanoma cancers with minimum damage to the surrounding normal skin is guided by the histopathologic examination of each excision during Mohs micrographic surgery. The preparation of frozen histopathology sections typically requires 20-45 min per excision. Real-time confocal reflectance microscopy offers an imaging method potentially to avoid frozen histopathology and prepare noninvasive (optical) sections within 5 min. Skin excisions (≈ 1 mm thick) from Mohs surgeries were washed with 5{\%} acetic acid and imaged with a confocal cross-polarized microscope. The confocal images were compared with the corresponding histopathology. Acetic acid causes compaction of chromatin that increases light back-scatter and makes the nuclei bright and easily detectable. Crossed-polarization strongly enhances the contrast of the nuclei because the compacted chromatin depolarizes the illumination light whereas the surrounding cytoplasm and normal dermis does not. Fast low-resolution examination of cancer lobules in wide fields of view followed by high-resolution inspection of nuclear morphology in small fields of view is possible; this is similar to the procedure for examining histopathology sections. Both the Mohs surgeon and the patient will potentially save several hours per day in the operating room. Fast confocal reflectance microscopic examination of excisions (of any thickness) may improve the management of surgical pathology and guide microsurgery of any human tissue.",
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