Topical aluminum chloride and Monsel's solution block toluidine blue staining in Mohs frozen sections: Mechanism and solution Journal Article
| Authors: | Chen, C. L.; Wilson, S.; Afzalneia, R.; Chen, C. S. J. |
| Article Title: | Topical aluminum chloride and Monsel's solution block toluidine blue staining in Mohs frozen sections: Mechanism and solution |
| Abstract: | BACKGROUND: A diminished-staining artifact is observed in some Mohs frozen sections that are stained in toluidine blue (T-blue). Such an artifact, not yet described in the literature, may interfere with a Mohs surgeon's accurate reading. The authors hypothesize that topical hemostatic agents, aluminum chloride, and Monsel's solution are the causative factors. OBJECTIVE: To evaluate the aforementioned topical hemostatic agents as a potential cause of the nonstaining artifact, to propose the mechanism associated with this phenomenon, and to develop a method to prevent or rectify the problem. MATERIALS AND METHODS: Leftover Mohs frozen sections and specimens were treated with aluminum chloride or Monsel's solution and processed with routine Mohs histology. RESULTS: Nonstaining artifact is reproduced in aluminum chloride or Monsel's solution-treated ex vivo skin specimens. The authors found that ethylenediaminetetraacetic acid (EDTA), a chelating agent, can reverse the staining blockage. Such a finding suggests that aluminum or ferric cations bind to tissue and subsequently inhibit T-blue from interacting with the tissue. Direct binding of ferric cations to the tissue section is demonstrated with Prussian blue iron staining. CONCLUSION: By rinsing Mohs frozen sections in an EDTA solution before T-blue staining, the authors could prevent hemostatic agent-induced nonstaining. Applying an EDTA wash and restaining the slides can correct the same artifact. |
| Journal Title: | Dermatologic Surgery |
| Volume: | 45 |
| Issue: | 8 |
| ISSN: | 1076-0512 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2019-09-01 |
| Start Page: | 1019 |
| End Page: | 1025 |
| Language: | English |
| DOI: | 10.1097/dss.0000000000001761 |
| PUBMED: | 30640770 |
| PROVIDER: | scopus |
| PMCID: | PMC8409320 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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