Innovative 19-minute rapid cytokeratin immunostaining of nonmelanoma skin cancer in Mohs micrographic surgery.
BACKGROUND
Dense inflammation can obscure nonmelanoma skin cancer (NMSC) on frozen sections, prompting removal of additional layers to ensure negative margins. Cytokeratin (CK) immunostaining in Mohs micrographic surgery (MMS) has been examined and found to be useful but is limited by lengthy 1-hour processing.


OBJECTIVE
Our objective was to develop an effective ultrarapid CK frozen section immunostain to be used during MMS in cases of NMSC with dense or perineural inflammation.


METHODS
An ultrarapid immunostain with a mixture of AE1/AE3 monoclonal antibodies was performed in 21 MMS cases and compared with permanent sections prepared from the same material.


RESULTS
The ultrarapid CK protocol stained all of the cells in each of the 21 examples of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in frozen tissue in a way equivalent to immunostains being applied to permanent sections.


CONCLUSIONS
The 19-minute CK immunohistochemistry protocol in frozen tissue appears to be as effective at labeling tumor cells of SCC and BCC as methods requiring permanent sections. It is hopeful that this technique may prevent recurrences after MMS and limit the number of Mohs layers required to obtain free margins when inflammation is abundant. It also is effective in uncovering subtle perineural invasion.
Cherpelis
Basil S
BS
Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA. bcherpel@health.usf.edu
Turner
Logan
L
Ladd
Sharron
S
Glass
L Frank
LF
Fenske
Neil A
NA
D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm / Q000276:immunology; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005629:Frozen Sections / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins; D008297:Male; D015580:Mohs Surgery; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D013194:Staining and Labeling; D013997:Time Factors
D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D007633:Keratins