Peri-operative delineation of non-melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video-mosaicking Journal Article

Authors: Flores, E.; Yélamos, O.; Cordova, M.; Kose, K.; Phillips, W.; Lee, E. H.; Rossi, A.; Nehal, K.; Rajadhyaksha, M.
Article Title: Peri-operative delineation of non-melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video-mosaicking
Abstract: Background: The surgical removal of non-melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour-intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re-excisions. Reflectance confocal microscopy (RCM) with a new video-mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real-time, augmenting the traditional approaches of histopathology. Objective: To assess a new peri-operative RCM video-mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. Methods: Thirty-five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video-mosaics. Two RCM evaluators read and assessed video-mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. Results: Reflectance confocal microscopy videos and video-mosaics displayed acceptable imaging quality (resolution and contrast), pre-operatively in 32/35 (91%) NMSC lesions and intra-operatively in 29/35 lesions (83%). Pre-operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra-operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video-mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter-evaluator agreement (k = 0.59, P ≤ 0.0002). Conclusions: Peri-operative RCM video-mosaicking of NMSC margins directly on patients may potentially guide surgery in real-time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re-excisions. Further testing in larger studies is needed. © 2019 European Academy of Dermatology and Venereology
Journal Title: Journal of the European Academy of Dermatology and Venereology
Volume: 33
Issue: 6
ISSN: 0926-9959
Publisher: Wiley Blackwell  
Date Published: 2019-06-01
Start Page: 1084
End Page: 1091
Language: English
DOI: 10.1111/jdv.15491
PUBMED: 30811707
PROVIDER: scopus
PMCID: PMC6534461
Notes: Article -- Export Date: 1 July 2019 -- Source: Scopus
Citation Impact
MSK Authors
  1. Kishwer S Nehal
    243 Nehal
  2. Erica H Lee
    124 Lee
  3. Eileen Sunga Flores
    14 Flores
  4. Anthony Rossi
    206 Rossi
  5. Kivanc Kose
    72 Kose
  6. Miguel A Cordova
    84 Cordova