LITERATURE UPDATE


by one plastic surgeon from September 2017 to June 2023.


The primary outcomes were i)


recurrence, determined by excision of skin cancer demonstrated to be arising from post-excision scar tissue, and ii) concordance between intraoperative and final pathology. There were 1714 FSM procedures performed with a cohort averaging 73.8 years old and 57% male. Zero recurrences were identified (100% cure rate). Two cases (0.11%) were false negatives and the patients returned for re-excision. About 48.2% of cases were basal cell carcinoma while 40.7% were squamous cell carcinoma. The average number of stages per FSM procedure was 1.17. The mean defect size was 1.83 cm2. Complication rate was 2.28% (n=39), with the most common issue being bleeding that required suturing or cautery. The proposed FSM technique’s results demonstrate effective carcinoma removal comparable to MMS. Plastic surgeons may therefore utilise this technique to meet the growing demands of skin cancer surgery in the United States with equally effective outcomes.


Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis Young JN, Nguyen TA, Freeman SC et al. J Am Acad Dermatol. 2023 May;88(5):1060-1065.


doi: 10.1016/j.jaad.2023.01.019.


Mohs micrographic surgery (MMS) for melanoma practices vary among dermatologic surgeons. The


implementation of immunohistochemical staining in MMS for melanoma mitigates challenges associated with slide interpretation; however, the reliability of melanoma antigen recognised by T cells 1 (MART-1), the preferred immunostain for melanoma, has yet to be compared with permanent section pathology. The objective of this study is to assess concordance rates of MART-1 frozen sections and permanent section pathologic interpretation of melanoma treated with MMS. A dual-centre retrospective analysis was conducted to collect concordance and demographic data. Χ2 tests were performed for group comparisons of categorical variables. Of the 379 permanent sections sent,


367 were concordant with frozen section pathology for an overall concordance rate of 96.8%. Cases were stratified into indeterminately concordant and


80


Basal cell carcinoma typically removed using the Mohs micrographic surgery technique.


indisputably concordant. Twenty- two (6%) cases were indeterminately concordant, whereas 345 (94.0%) cases were indisputably concordant. The concordance rate is derived from a comparison of adjacent tissue margins, an inevitable consequence of utilising two techniques. To the authors’ knowledge, this study


represents the largest investigation examining concordance rates of MART-1 frozen sections in Mohs for melanoma. High concordance disputes the ongoing need for additional permanent margins when using MART-1 in routine cases.


Evaluation of different haematoxylin stain subtypes for the optimal microscopic interpretation of cutaneous malignancy in Mohs frozen section histological procedure Gabriel JA, Shams M, Orchard GE. Br J Biomed Sci 2021 Apr;78(2):78-86. doi: 10.1080/09674845.2020.1838075.


The Mohs technique employs mainly H&E-stained frozen sections for surgical margin assessment of cutaneous excisions, utilising microscopic evaluation of the complete, circumferential, peripheral and deep margins. This study aimed to determine which mordant- based haematoxylin (Ehrlich’s, Cole’s, Mayer’s, Gill’s I, Gill’s II, Gill’s III, Weigert’s, Harris’ or Carazzi’s) produced the optimal morphological clarity of staining for the identification of cellular and tissue morphology of cutaneous basal cell carcinoma (BCC).


In total, 100 anonymised patient cases


were selected, sectioned and stained with each haematoxylin subtype. The


slides were independently evaluated microscopically by two assessors. A combined score was generated to determine the sensitivity (defined as the intensity of haematoxylin staining being too weak or too strong, and the colour appearance of the haematoxylin not being blue/black) and specificity (defined as the appearance of background staining with haematoxylin, uneven staining and staining deposits) for each of the nine haematoxylin subtypes. The scoring criteria were based on the UKNEQAS CPT Mohs procedure assessment criteria. The scores generated for specificity identified Carazzi’s haematoxylin as best performing (99.2%) followed by Gill’s III (98.4%), Ehrlich’s (98.2%) and Harris’ (85.0%). The sensitivity score again identified Carazzi’s as producing the best result (85.0%) followed by Weigert’s (83.4%), Ehrlich’s (81.6%) and Gill’s III (80.4%).


Carazzi’s haematoxylin is the most optimal staining dye for the identification of BCC tumour for use as part of the Mohs micrographic surgery procedure.


Assessment of a Deep Learning Model Trained on Permanent Pathology for the Classification of Squamous Cell Carcinoma in Mohs Frozen Sections: Lessons Learned


Rios-Duarte JA, Choudhary A, Nassir S et al. Dermatol Surg. 2025 Jul 9. doi: 10.1097/DSS.0000000000004758. Online ahead of print.


There is a scarcity of artificial intelligence models trained on frozen pathology. One way to expand the clinical utility of


SEPTEMBER 2025 WWW.PATHOLOGYINPRACTICE.COM


M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara CC BY 2.0 Wikimedia Commons


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