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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MSK Authors
  1. Chih-Shan Jason Chen
    55 Chen
  2. Steven Wilson
    4 Wilson
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