Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology

França, Katlein; Alqubaisy, Yasser; Hassanein, Ashraf M.; Nouri, Keyvan; Lotti, Torello

doi:10.1007/s10354-016-0528-0

Cited by 10 publications

(9 citation statements)

References 77 publications

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“…The technique is extremely effective for BCC treatment, but the histopathologic processing is time-consuming and highly dependent on the skills and experience of the evaluating Mohs surgeon. Several normal structures and processes within the skin tissue create visual artifacts that can hamper a correct identification of tumor loci in stained sections, for example, hair follicles, inflammation, and nerve proximity (4). In these situations, an objective adjunctive technique can significantly aid in delineation of microscopic tumors without reliance on visual histopathologic evaluation.…”

mentioning

confidence: 99%

Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging

Margulis

Chiou

Aasi

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

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Detection of microscopic skin lesions presents a considerable challenge in diagnosing early-stage malignancies as well as in residual tumor interrogation after surgical intervention. In this study, we established the capability of desorption electrospray ionization mass spectrometry imaging (DESI-MSI) to distinguish between micrometer-sized tumor aggregates of basal cell carcinoma (BCC), a common skin cancer, and normal human skin. We analyzed 86 human specimens collected during Mohs micrographic surgery for BCC to cross-examine spatial distributions of numerous lipids and metabolites in BCC aggregates versus adjacent skin. Statistical analysis using the least absolute shrinkage and selection operation (Lasso) was employed to categorize each 200-µm-diameter picture element (pixel) of investigated skin tissue map as BCC or normal. Lasso identified 24 molecular ion signals, which are significant for pixel classification. These ion signals included lipids observed at / 200-1,200 and Krebs cycle metabolites observed at / < 200. Based on these features, Lasso yielded an overall 94.1% diagnostic accuracy pixel by pixel of the skin map compared with histopathological evaluation. We suggest that DESI-MSI/Lasso analysis can be employed as a complementary technique for delineation of microscopic skin tumors.

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mentioning

confidence: 99%

Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging

Margulis

Chiou

Aasi

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

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“…The factors that cause treatment failure through SEPMC include main tumors with skip areas, perineural invasion of some high-risk BCCs, and inconsistency between the surgeon and the pathologist in marking the tissue samples for pathologic assessment. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

“…BCCs with high-risk pathologic features – including morphoeic, infiltrative, and micronodular types – are more likely to develop skip area dissemination and perineural invasion; therefore, recurrence is possible even with MMS. 2 , 11 , 12 , 13 , 16 , 17…”

Section: Discussionmentioning

confidence: 99%

Outcome of staged excision with pathologic margin control in high-risk basal cell carcinoma of the head region

Kavoussi

Ebrahimi

et al. 2020

Anais Brasileiros de Dermatologia

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Background High-risk basal cell carcinoma involves a significant rate of basal cell carcinoma that requires Mohs micrographic surgery for definitive treatment. Staged excision with pathologic margin control is a simple, accessible, and curative procedure suggested for the treatment of high-risk basal cell carcinoma. Objective To evaluate the results of staged excision of high-risk basal cell carcinoma in the head region. Methods This interventional study was performed on patients with high-risk basal cell carcinoma, who underwent staged excision until the margins were free of tumor. Results A total of 122 patients (47 females and 75 males) with mean age of 57.66 ± 9.13 years were recruited in this study. Nasal and nodular types were the most common of both clinical and pathologic forms, respectively. Further, 89.3 % of cases were cured by staged excision after four years of follow-up. There was a significant relationship between treatment outcomes and recurrent lesions, multiplicity of risk factors, long-standing disease, and pathologic type. There was also a significant association between the number of surgical excisions and multiplicity of risk factors, as well as recurrence, location, and size of basal cell carcinoma. Study limitations Lack of magnetic resonance imaging assessment in cases of suspected perineural invasion. Conclusions High-risk basal cell carcinoma had a high cure rate by staged excision. Patients with more risk factors and those with nasal and recurrent basal cell carcinoma required more staged excisions. Failure of treatment is more probable in patients with more risk factors, long-standing lesions, and high-risk pathologic and recurrent basal cell carcinomas.

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“…The fibrous tissue can resemble nerve fibers, introducing complications when distinguishing between PF and PNI [149]. Excision of large margins and administration of specific stains, for instance, S-100 protein, are beneficial when distinguishing PF and PNI [149,150]. Compared to H&E staining, S-100 protein IHC staining increases the accuracy of PNI detection [31].…”

Section: Histologic Mimics Of Perineural Invasion 71 Peritumoral Fibr...mentioning

confidence: 99%

Unraveling the Mysteries of Perineural Invasion in Benign and Malignant Conditions

Bahmad,

Gogola,

Rejzer

et al. 2023

Current Oncology

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Perineural invasion (PNI) is defined as the dissemination of neoplastic cells within the perineural space. PNI can be a strong indicator of malignancy and is linked to poor prognosis and adverse outcomes in various malignant neoplasms; nevertheless, it can also be seen in benign pathologic conditions. In this review article, we discuss various signaling pathways and neurotrophic factors implicated in the development and progression of PNI. We also describe the methodology, benefits, and limitations of different in vitro, ex vivo, and in vivo models of PNI. The spectrum of presentation for PNI can range from diffuse spread within large nerves (“named” nerves) all the way through localized spread into unnamed microscopic nerves. Therefore, the clinical significance of PNI is related to its extent rather than its mere presence or absence. In this article, we discuss the guidelines for the identification and quantification of PNI in different malignant neoplasms based on the College of American Pathologists (CAP) and World Health Organization (WHO) recommendations. We also describe benign pathologic conditions and neoplasms demonstrating PNI and potential mimics of PNI. Finally, we explore avenues for the future development of targeted therapy options via modulation of signaling pathways involved in PNI.

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Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology

Cited by 10 publications

References 77 publications

Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging

Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging

Outcome of staged excision with pathologic margin control in high-risk basal cell carcinoma of the head region

Unraveling the Mysteries of Perineural Invasion in Benign and Malignant Conditions

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