Who should have Mohs micrographic surgery?:

Perioral lesions and dermatoses

The purpose of this article is to review the common neoplasms, infections, and inflammatory dermatoses that may present around or near the mouth. Dental professionals are well positioned to evaluate perioral skin conditions, further contributing to patients' general health. This article includes a review of seborrheic keratosis, warts, actinic keratoses, actinic cheilitis, and squamous cell carcinoma, among several other perioral cutaneous lesions.

Rapid screening of cancer margins in tissue with multimodal confocal microscopy

BACKGROUND

Complete and accurate excision of cancer is guided by the examination of histopathology. However, preparation of histopathology is labor intensive and slow, leading to insufficient sampling of tissue and incomplete and/or inaccurate excision of margins. We demonstrate the potential utility of multimodal confocal mosaicing microscopy for rapid screening of cancer margins, directly in fresh surgical excisions, without the need for conventional embedding, sectioning, or processing.

MATERIALS AND METHODS

A multimodal confocal mosaicing microscope was developed to image basal cell carcinoma margins in surgical skin excisions, with the resolution that shows nuclear detail. Multimodal contrast is with fluorescence for imaging nuclei and reflectance for cellular cytoplasm and dermal collagen. Thirty-five excisions of basal cell carcinomas from Mohs surgery were imaged, and the mosaics analyzed by comparison with the corresponding frozen pathology.

RESULTS

Confocal mosaics are produced in about 9 min, displaying tissue in fields of view of 12 mm with ×2 magnification. A digital staining algorithm transforms black and white contrast to purple and pink, which simulates the appearance of standard histopathology. Mosaicing enables rapid digital screening, which mimics the examination of histopathology.

CONCLUSIONS

Multimodal confocal mosaicing microscopy offers a technology platform to potentially enable real-time pathology at the bedside. The imaging may serve as an adjunct to conventional histopathology to expedite screening of margins and guide surgery toward more complete and accurate excision of cancer.

[Mohs surgery in basal cell carcinoma on the face]

BACKGROUND

Basal cell carcinoma may have a locally aggressive growth pattern. This type of cancer is often located on the face and is difficult to limit clinically. Normal excision and tumour destructive treatment often lead to recurrence of the tumour. Mohs surgery is a radical technique for removing this type of lesion.

MATERIAL AND METHOD

This review article is based on articles identified by searching in PubMed with the search words "Mohs surgery" and "basal cell carcinoma", as well as personal experience.

RESULTS

10-15 % of all basal cell carcinomas have an aggressive growth pattern with sub clinical ramifications. Mohs surgery involves use of peroperative histological assessment of horizontal frozen sections, meaning that 100 % of the resection surface can be assessed. The objective is to reduce the risk of recurrence. Since the method saves tissue, simpler reconstruction can often be chosen. Mohs surgery is resource-demanding, but with the lower risk of recurrence, the method can be cost-effective when used for the correct indications.

INTERPRETATION

Mohs surgery should be considered in basal cell carcinoma with an aggressive growth pattern on the face.

Melanoma: epidemiology, diagnosis, treatment, and outcomes

Melanoma is a skin cancer that arises from the malignant transformation of melanocytes. Although it is typically considered a pigmented lesion, the clinical presentation of melanoma can vary greatly. With increased efforts in screening and detection of early-stage melanoma, researchers and clinicians hope to improve clinical outcomes for patients with melanoma. Novel immunotherapies directed at specific molecular targets in the pathogenesis of melanoma usher in a new era of treatment of advanced melanoma.