Current Progress of Immunostains in Mohs Micrographic 
Surgery: A Review

Abstract

Mohs micrographic surgery is often considered the treatment of choice for a variety of skin malignancies. In recent years, the application of immunostaining techniques has facilitated the successful removal of a number of common and less common cutaneous malignancies, including basal cell carcinoma, squamous cell carcinoma, malignant melanoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, sebaceous carcinoma, atypical fibroxanthoma, extramammary Paget's disease, and even sarcomas. Immunostains highlight the tumor cells and allow the Mohs surgeons to pinpoint and eliminate the residual tumor at the surgical margin. It is especially helpful when a tumor presents with subtle or nonspecific histologic features or when a tumor is masked in a pocket of dense inflammation. However, the cost, the labor, and the time consumption are of concern to many of our peers, as are the diversity of antigens, which may overwhelm some. This article serves as a review of the literature on current uses of immunostaining in Mohs micrographic surgery and as a summary of their realistic applications in the dermatologic surgeon's practice. We conclude that immunohistochemical technique has played an important role in Mohs surgery advancement. With greater use and more cost-effective staining methods, we believe that the use of immunostains in a Mohs practice will become routine.

Mohs micrographic surgery at the Skin and Cancer Foundation Australia, 10 years later (1997 vs 2007)

“…There has been a recent review 8 on the current uses of immunostaining in MMS and the authors concluded that immunohistochemical technique has played an important role in MMS advancement. 8 This article compares all patients treated with MMS at SCFA, Westmead in 1997 against those treated in 2007 at the same institution with the objective of evaluating changes in the type of patients, type of skin cancer, and repair used to close the defects after surgery.…”

Microcystic Adnexal Carcinoma

“…In MAC, staining is scattered and peripheral, particularly in deeper parts of the tumor. Epithelial membrane antigen is positive in MAC and helps differentiate from morphoeic BCC [ 40 ] . Staining for cytokeratin 15 may be useful in excluding basal-cell and squamous cell carcinoma but not desmoplastic trichoepithelioma [ 41 ] .…”

Microcystic adnexal carcinoma: A focused review and updates

“…Some special stains are especially useful in banal-appearing tumors, specifically if significant inflammation is present to mask the tumor cells. Special stains include CEA, AE1/AE3, and EMA which all stain positive and others like CK20 which stains negative (Thosani et al, 2008).…”