Immunostaining in Mohs Micrographic Surgery: A Review

Tal, Abdel Kader El; Abrou, Ayad E.; Stiff, Mark A.; Mehregan, David A.

doi:10.1111/j.1524-4725.2009.01432.x

Cited by 53 publications

(38 citation statements)

References 78 publications

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“…S100, while the most sensitive stain, is also the least specific, limiting its utility. Melan A is more specific, but can fail to stain desmoplastic melanomas [22,23]. MITF, a nuclear stain, has been demonstrated to be useful in distinguishing LM from chronically sun-damaged skin, by demonstrating melanocytic nuclear density of greater than or equal to 9 μm [21].…”

Section: Diagnosismentioning

confidence: 98%

“…This technique offers the advantages of tissue-sparing with removal of minimal surrounding normal tissue, and improved efficiency/decreased cost of treatment with same-day removal of the lesion and repair. Rapid immunostains, most frequently Melan A/MART 1, are commonly used during Mohs surgery on frozen sections to improve identification of abnormal melanocytes [22]. An alternative approach is staged excision with paraffin-embedding then en face sectioning of margins, the so-called 'Slow Mohs' technique, which allows 100% margin examination.…”

Section: Treatmentmentioning

confidence: 99%

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Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

2015

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Lentigo maligna and lentigo maligna melanomas present diagnostic and treatment dilemmas due to their frequent presence within a background of sun-damaged skin, and their location on cosmetically and functionally sensitive areas. As the incidence of this entity is increasing, diagnostic and management controversies have developed. While surgery remains the gold standard of treatment, nonsurgical treatment options are also emerging for both adjunctive and primary therapy.

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Section: Diagnosismentioning

confidence: 98%

Section: Treatmentmentioning

confidence: 99%

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

2015

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“…(1) The drive to engineer microscopes that can perform in the surgical theater is perhaps strongest in Mohs surgery, which resects mainly non-melanoma skin cancers: basal cell (BCC) and squamous cell carcinoma (SCC). The two main reasons that rapid pathology is greatly needed in Mohs surgery are: non-melanoma skin cancers are widely prevalent and the key limiting factor in curative skin cancer excision is the costly, cumbersome and timeconsuming ascertainment of negative surgical margins by the Mohs surgeon with hematoxylin and eosin (H&E)-stained frozen section histology (2)(3)(4). Currently, 3.5 million new cases of non-melanoma skin cancer per year are treated with Mohs surgery (5).…”

Section: Introductionmentioning

confidence: 99%

Line-scanning, stage scanning confocal microscope

2016

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We created a line-scanning, stage scanning confocal microscope as part of a new procedure: video assisted micrographic surgery (VAMS). The need for rapid pathological assessment of the tissue on the surface of skin excisions very large since there are 3.5 million new skin cancers diagnosed annually in the United States. The new design presented here is a confocal microscope without any scanning optics. Instead, a line is focused in space and the sample, which is flattened, is physically translated such that the line scans across its face in a direction perpendicular to the line its self. The line is 6mm long and the stage is capable of scanning 50 mm, hence the field of view is quite large. The theoretical diffraction-limited resolution is 0.7um lateral and 3.7um axial. However, in this preliminary report, we present initial results that are a factor of 5-7 poorer in resolution. The results are encouraging because they demonstrate that the linear array detector measures sufficient signal from fluorescently labeled tissue and also demonstrate the large field of view achievable with VAMS.

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“…MMS is also a more time‐efficient procedure where the tumor‐free margins can be confirmed on the same day prior to reconstruction, in comparison to WLE, which is often a staged procedure. MMS approach may be more suited for more challenging regions such as photodamaged skin and areas of anatomical and cosmetic importance; however, the interpretation of MIS on frozen section even with immunohistochemical stains can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

Phan

Loya

2019

Int J Dermatology

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Background With the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS surgery for MIS. Methods We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS. Results There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924). Conclusion Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE.

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Immunostaining in Mohs Micrographic Surgery: A Review

Abstract: Immunostaining offers an advantage in MMS. Large, randomized, prospective studies comparing the different immunostains are still lacking in the literature. The authors have indicated no significant interest with commercial supporters.

Cited by 53 publications

References 78 publications

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

Line-scanning, stage scanning confocal microscope

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

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