Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions Journal Article
| Authors: | Patel, Y. G.; Nehal, K. S.; Aranda, I.; Li, Y.; Halpern, A. C.; Rajadhyaksha, M. |
| Article Title: | Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions |
| Abstract: | Precise removal of basal cell carcinomas (BCCs) with minimal damage to the surrounding normal skin is guided by the examination of frozen histology of each excision during Mohs surgery. The preparation of frozen histology is slow, requiring 20 to 45 min per excision. Confocal reflectance mosaicing may enable rapid detection of BCCs directly in surgical excisions, with minimal need for frozen histology. Soaking the excisions in acetic acid rapidly brightens nuclei and enhances BCC-to-dermis contrast. Clinically useful concentrations of acetic acid from 10 to 1% require 30 s to 5 min, respectively. A tissue fixture precisely controls the stability, flatness, tilt, and sag of the excisions, which enables mosaicing of 36 × 36 images to create a field of view of 12 × 12 mm. This simulates a 2x magnification view in light microscopes, which is routinely used by Mohs surgeons to examine frozen histology. Compared to brightfield, cross-polarization enhances contrast and detectability of BCCs in the papillary dermis but not in the reticular dermis. Comparison of mosaics to histology shows that nodular, micronodular, and superficial BCCs are easily detected. However, infiltrative and sclerosing BCCs tend to be obscured within the surrounding bright dermis. The mosaicing method currently requires 9 min, and thus may expedite Mohs surgery. © 2007 Society of Photo-Optical Instrumentation Engineers. |
| Keywords: | methodology; basal cell carcinoma; confocal microscopy; image interpretation, computer-assisted; microscopy, confocal; skin neoplasms; in vitro study; pathology; histology; skin tumor; computer assisted diagnosis; tumors; surgery; carcinoma, basal cell; reflection; mohs surgery; chemosurgery; acetowhitening; basal cell carcinomas; acetic acid; surgery, computer-assisted; computer assisted surgery; confocal optics; mosaicing method |
| Journal Title: | Journal of Biomedical Optics |
| Volume: | 12 |
| Issue: | 3 |
| ISSN: | 1083-3668 |
| Publisher: | SPIE |
| Date Published: | 2007-06-27 |
| Start Page: | 034027 |
| Language: | English |
| DOI: | 10.1117/1.2750294 |
| PUBMED: | 17614735 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 27" - "Export Date: 17 November 2011" - "CODEN: JBOPF" - "Source: Scopus" |
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