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Research Papers

Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions

[+] Author Affiliations
Yogesh G. Patel, Kishwer S. Nehal

Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, Dermatology Service, Floor #2, New York, New York 10022

Iana Aranda, Yongbiao Li

Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Research Engineering Laboratory, Room RRL 551, New York, New York 10021

Allan C. Halpern, Milind Rajadhyaksha

Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, Dermatology Service, Floor #2, New York, New York 10022

J. Biomed. Opt. 12(3), 034027 (June 08, 2006February 02, 2007February 05, 2007June 27, 2007). doi:10.1117/1.2750294
History: Received June 08, 2006; Revised February 02, 2007; Accepted February 05, 2007; Published June 27, 2007
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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 45min 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 30s to 5min, 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 12×12mm. This simulates a 2× 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 9min, and thus may expedite Mohs surgery.

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© 2007 Society of Photo-Optical Instrumentation Engineers

Citation

Yogesh G. Patel ; Iana Aranda ; Allan C. Halpern ; Milind Rajadhyaksha ; Yongbiao Li, et al.
"Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions", J. Biomed. Opt. 12(3), 034027 (June 08, 2006February 02, 2007February 05, 2007June 27, 2007). ; http://dx.doi.org/10.1117/1.2750294


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