Feasibility of intraoperative imaging during Mohs surgery with reflectance confocal microscopy Conference Paper

Authors: Flores, E. S.; Cordova, M.; Kose, K.; Phillips, W.; Nehal, K.; Rajadhyaksha, M.
Title: Feasibility of intraoperative imaging during Mohs surgery with reflectance confocal microscopy
Conference Title: Photonic Therapeutics and Diagnostics X
Abstract: Mohs surgery for the removal of non-melanoma skin cancers (NMSCs) is performed in stages, while being guided by the examination for residual tumor with frozen pathology. However, preparation of frozen pathology at each stage is timeconsuming and labor-intensive. Real-time intraoperative reflectance confocal microscopy (RCM) may enable rapid detection of residual tumor directly in surgical wounds on patients. We report initial feasibility on twenty-one patients, using 35% AlCl3 for nuclear contrast. Imaging was performed in quadrants in the wound, to simulate the Mohs surgeona's examination of pathology. Images and videos of the epidermal and dermal margins were found to be of clinically acceptable quality. Bright nuclear morphology was identified at the epidermal margin. The presence of residual BCC/SCC tumor and normal skin features could be detected in the peripheral and deep dermal margins. Nuclear morphology was detectable in residual BCC/SCC tumors. Intraoperative RCM imaging may enable detection of residual tumor, directly on Mohs patients, and may serve as an adjunct for frozen pathology. However, a stronger source of contrast will be necessary, and also a smaller device with an automated approach for imaging in the entire wound in a rapid and controlled manner for clinical utility. © 2014 SPIE.
Keywords: squamous cell carcinoma; reflectance confocal microscopy; basal cell carcinoma; confocal microscopy; pathology; oncology; morphology; tumors; surgery; reflectance confocal microscopies; reflection; mohs surgery; dermatology; skin cancers; non-melanoma skin cancer; intraoperative imaging; intra-operative imaging
Journal Title Proceedings of SPIE
Volume: 8926
Conference Dates: 2014 Feb 1-2
Conference Location: San Francisco, CA
ISBN: 0277-786X
Publisher: SPIE  
Date Published: 2014-03-04
Start Page: 89260F
End Page: 89260F-12
Language: English
DOI: 10.1117/12.2039590
PROVIDER: scopus
Notes: Progress in Biomedical Optics and Imaging - Proceedings of SPIE -- Progr. Biomed. Opt. Imaging Proc. SPIE -- Conference code: 103479 -- Export Date: 1 May 2014 -- Sponsors: The Society of Photo-Optical Instrumentation Engineers (SPIE) -- 1 February 2014 through 2 February 2014 -- Source: Scopus
Citation Impact
MSK Authors
  1. Kishwer S Nehal
    243 Nehal
  2. Eileen Sunga Flores
    14 Flores
  3. Kivanc Kose
    72 Kose
  4. Miguel A Cordova
    84 Cordova