Adjuvant cytokeratin staining in Mohs micrographic surgery for basal cell carcinoma.
BACKGROUND
Mohs micrographic surgery (MMS) is a technique that offers excellent cure rates in the treatment of basal cell carcinoma (BCC). One of the reasons for its success is the 100% visualization of the resection margins. Still, recurrences do occur in 2% to 5% of the treated BCCs. It has been suggested that BCC cells in frozen sections stained with hematoxylin and eosin (H&E) may be missed.


OBJECTIVE
To determine whether an additional immunohistochemical staining with a cytokeratin marker (MNF 116) indicates BCC cells in sections in which the H&E-stained frozen sections were negative.


METHODS
The Mohs procedure was performed under standard conditions in which H&E-stained slides were judged by the Mohs surgeon and the pathologist. After the H&E slides where judged negative, an extra slide was stained using immunohistochemistry and a monoclonal antibody against cytokeratin (MNF 116).


RESULTS
A total of 143 complete slides were stained and judged by two Mohs surgeons and a pathologist. One of the 143 slides stained with MNF 116 showed positive staining where the H&E slides were negative, which is 0.7% of the slides. However, this single slide represents a failure of nearly 2% of the treated patients.


CONCLUSIONS
Frozen sections stained with H&E in MMS offer enough security in detecting BCC cells during surgery; however, adjuvant cytokeratin staining can be useful in very selected cases of aggressive growing BCC.
Smeets
Nicole W J
NW
Department of Dermatology, University Hospital Maastricht, Erasmus MC Rotterdam, The Netherlands. nsme@sder.azm.nl
Stavast-Kooy
Angela J W
AJ
Krekels
Gertruud A M
GA
Daemen
Mat J A P
MJ
Neumann
H A Martino
HA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D005629:Frozen Sections; D006416:Hematoxylin; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis*; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*
D000911:Antibodies, Monoclonal; D004396:Coloring Agents; D007633:Keratins; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin