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Proceedings Paper

Feasibility of intraoperative imaging during Mohs surgery with reflectance confocal microscopy
Author(s): Eileen S. Flores; Miguel Cordova; Kivanc Kose; William Phillips; Kishwer Nehal; Milind Rajadhyaksha
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Paper 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 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. 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.

Paper Details

Date Published: 4 March 2014
PDF: 12 pages
Proc. SPIE 8926, Photonic Therapeutics and Diagnostics X, 89260F (4 March 2014); doi: 10.1117/12.2039590
Show Author Affiliations
Eileen S. Flores, Memorial Sloan-Kettering Cancer Ctr. (United States)
Miguel Cordova, Memorial Sloan-Kettering Cancer Ctr. (United States)
Kivanc Kose, Memorial Sloan-Kettering Cancer Ctr. (United States)
William Phillips, Memorial Sloan-Kettering Cancer Ctr. (United States)
Kishwer Nehal, Memorial Sloan-Kettering Cancer Ctr. (United States)
Milind Rajadhyaksha, Memorial Sloan-Kettering Cancer Ctr. (United States)

Published in SPIE Proceedings Vol. 8926:
Photonic Therapeutics and Diagnostics X
Bernard Choi; Hyun Wook Kang; Brian J. F. Wong M.D.; Guillermo J. Tearney M.D.; Andreas Mandelis; Nikiforos Kollias; Kenton W. Gregory M.D.; Justus F. Ilgner M.D.; Haishan Zeng; Laura Marcu, Editor(s)

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