Current Histologic Preparation Methods for Mohs Micrographic Surgery

Abstract

Automation of routine slide preparation with a Linistainer decreased staining variability by providing a consistent environment, and decreased processing time. Most laboratories do not perform immunostaining. The relatively high cost of reagents, lack of a reliable automated process, the additional time to process specimens, and the additional technician and physician time makes the procedure impractical for many laboratories.

Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma

“…5 However, the ill-defined clinical nature of these tumors, often with wide subclinical extension of atypical melanocytes, coupled with the frequent location on the face, make achieving clear margins problematic. A standard 5-mm excision margin will be inadequate in many cases, 6,7 and recurrence rates of LM after standard excision may approach 20%. 8 Mohs micrographic surgery (MMS) has been advocated for margincontrolled excision of LM and LMM, [9][10][11] though this remains controversial given the challenges in assessing melanocyte atypia in frozen sections.…”

“…A recent study of 200 cases of LM/LMM treated by MMS with Mel-5 immunostaining showed a recurrence rate of 0.5% after a follow-up period of 38 months 10. However, few Mohs laboratories (\15% in a recent survey) currently utilize immunostains 6. …”

Current Progress of Immunostains in Mohs Micrographic Surgery: A Review

“…As Robinson revealed in her survey of practices across the country, the majority of dermatologic surgeons are staining their slides with H&E (BCC = 87%, SCC = 95%) and toluidine blue (BCC = 13%, SCC = 5%). 6 With good results reported using these two stains, is there a need or a place for immunohistochemistry in the examination of BCC and SCC? Several authors have found utility for immunostains in difficult-to-interpret cases.…”

“…Only 12% (13/108) of laboratories surveyed performed immunostains on frozen sections, with the majority using stains for melanoma, BCC, and SCC. 6 The cost is significantly greater than that for hematoxylin and eosin (H&E) processingFapproximately $24 per slide if processed by hand. 7 In Robinson's survey, only one laboratory was using an automatic stainer for processing of their immunohistochemistry, which can cost between $30,000 and $50,000 for the initial setup.…”

“…7 In Robinson's survey, only one laboratory was using an automatic stainer for processing of their immunohistochemistry, which can cost between $30,000 and $50,000 for the initial setup. 6,7 There has been an increasing interest in immunostaining within the Mohs surgery community. In the past 2 decades, the list of tumor markers used for immunostains in Mohs surgery has grown longer and longer, newer protocols have been reported, and more studies have been published.…”