Research Papers

Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology

[+] Author Affiliations
Daniel S. Gareau

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

Yongbiao Li

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

Billy Huang

Bronx High School of Science, 75 West 205th Street, Bronx, New York 10468

Zach Eastman

Lucid Inc., 2320 Brighton Henrietta T/L Road, Rochester, New York 14623

Kishwer S. Nehal, Milind Rajadhyaksha

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

J. Biomed. Opt. 13(5), 054001 (September 22, 2008). doi:10.1117/1.2981828
History: Received March 21, 2008; Accepted April 01, 2008; Published September 22, 2008
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Mosaicing of confocal images enables observation of nuclear morphology in large areas of tissue. An application of interest is rapid detection of basal cell carcinomas (BCCs) in skin excisions during Mohs surgery. A mosaic is currently created in less than 9min, whereas preparing frozen histology requires 20to45min for an excision. In reflectance mosaics, using acetic acid as a contrast agent to brighten nuclei, large and densely nucleated BCC tumors were detectable in fields of view of 12×12mm (which is equivalent to a 2×-magnified view as required by Mohs surgeons). However, small and sparsely nucleated tumors remained undetectable. Their diminutive size within the large field of view resulted in weak light backscatter and contrast relative to the bright surrounding normal dermis. In fluorescence, a nuclear-specific contrast agent may be used and light emission collected specifically from nuclei but almost none from the dermis. Acridine orange of concentration 1mM stains nuclei in 20s with high specificity and strongly enhances nuclear-to-dermis contrast of BCCs. Comparison of fluorescence mosaics to histology shows that both large and small tumors are detectable. The results demonstrate the feasibility of confocal mosaicing microscopy toward rapid surgical pathology to potentially expedite and guide surgery.

Figures in this Article
© 2008 Society of Photo-Optical Instrumentation Engineers

Citation

Daniel S. Gareau ; Yongbiao Li ; Billy Huang ; Zach Eastman ; Kishwer S. Nehal, et al.
"Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology", J. Biomed. Opt. 13(5), 054001 (September 22, 2008). ; http://dx.doi.org/10.1117/1.2981828


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