Evaluating ex vivo fluorescence confocal microscopy images of basal cell carcinomas in Mohs excised tissue

Br J Dermatol. 2014 Sep;171(3):561-70. doi: 10.1111/bjd.13070. Epub 2014 Aug 13.


Background: Fluorescence confocal microscopy (FCM) is an emerging technology for rapid imaging of excised tissue, without the need for frozen- or fixed-section processing. Basal cell carcinomas (BCCs) can be detected in Mohs excisions although few studies have described the major BCC findings as seen on FCM.

Objectives: To describe the major BCC findings of excised tissue during Mohs surgery and to correlate them with histopathology.

Methods: Freshly excised tumours and frozen-thawed discarded tissue of BCC during Mohs surgery were analysed by means of FCM. A side-by-side correlation between FCM images and histological sections was performed. The FCM features of overlying skin and adnexal structures were also described.

Results: Sixty-four BCC cases were analysed. Distinct BCC types appeared unique in terms of shape and size of tumour islands [bigger in nodular (18/25), smaller and rounded in micronodular (7/7) and tiny cords for infiltrative ones (24/30)] and for the presence of clefting, palisading and increased nucleus/cytoplasm ratio. An excellent correlation was found between FCM and histological findings (Cohen's κ statistics = 0·9). In six cases, the presence of sebaceous glands and intense stroma reaction represented possible confounders.

Conclusions: Fluorescence confocal microscopy is a fast and new imaging technique that allows an excellent visualization of skin structures and BCC findings during Mohs surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Basal Cell / pathology*
  • Carcinoma, Basal Cell / surgery
  • Female
  • Humans
  • Male
  • Microscopy, Confocal / methods
  • Microscopy, Fluorescence / methods
  • Middle Aged
  • Mohs Surgery
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / surgery
  • Young Adult