Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: Initial clinical experience Journal Article

Authors: Flores, E. S.; Cordova, M.; Kose, K.; Phillips, W.; Rossi, A.; Nehal, K.; Rajadhyaksha, M.
Article Title: Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: Initial clinical experience
Abstract: Mohs surgery for the removal of nonmelanoma 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 time consuming and labor intensive. Real-time intraoperative reflectance confocal microscopy (RCM), combined with video mosaicking, may enable rapid detection of residual tumor directly in the surgical wounds on patients. We report our initial experience on 25 patients, using aluminum chloride for nuclear contrast. Imaging was performed in quadrants in the wound to simulate the Mohs surgeon'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 and detectable in residual NMSC tumors. The presence of residual tumor and normal skin features could be detected in the peripheral and deep dermal margins. Intraoperative RCM imaging may enable detection of residual tumor directly on patients during Mohs surgery, and may serve as an adjunct for frozen pathology. Ultimately, for routine clinical utility, a stronger tumor-to-dermis contrast may be necessary, and also a smaller microscope with an automated approach for imaging in the entire wound in a rapid and controlled manner. © 2015 The Authors.
Keywords: squamous cell carcinoma; reflectance confocal microscopy; basal cell carcinoma; confocal microscopy; pathology; tumors; surgery; reflectance confocal microscopies; reflection; mohs surgery; diseases; aluminum chloride; nonmelanoma skin cancer; chlorine compounds; nonmelanoma skin; intraoperative imaging; intra-operative imaging; video-mosaicking; video mosaicking
Journal Title: Journal of Biomedical Optics
Volume: 20
Issue: 6
ISSN: 1083-3668
Publisher: SPIE  
Date Published: 2015-02-23
Start Page: 061103
Language: English
DOI: 10.1117/1.jbo.20.6.061103
PROVIDER: scopus
PUBMED: 25706821
PMCID: PMC4405085
Notes: Export Date: 2 April 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Kishwer S Nehal
    243 Nehal
  2. Eileen Sunga Flores
    14 Flores
  3. Anthony Rossi
    206 Rossi
  4. Kivanc Kose
    72 Kose
  5. Miguel A Cordova
    84 Cordova