title: Does the dual use of toluidine blue and hematoxylin and eosin staining improve basal cell carcinoma detection by Mohs surgery trainees?
abstract: BACKGROUND
  Although a number of Mohs surgeons currently use Toluidine blue stain, alone or in combination with hematoxylin and eosin (H&E), the effects on the trainees' histologic accuracy of adding toluidine blue to their H&E training was unknown.
  
  
  OBJECTIVE
  To assess a trainees' histological accuracy when trained in a unit that routinely employs the dual staining technique and to determine whether the addition of toluidine blue improves, or impairs, the training process.
  
  
  METHODS
  A fellow examined slides from 403 consecutive Mohs cases over 3 months, from the start of his training period. H&E slides for each case were examined first, followed by the toluidine blue slides, with recordings made of the diagnosis based on each. The fellows' findings were then checked against those of the senior Mohs surgeons and a consultant histopathologist.
  
  
  RESULTS
  According to H&E alone, the fellow completely excised 96.3% of 352 basal cell carcinomas; this increased to 99.7% by adding toluidine blue. False-positive rates were 1.5% for H&E alone and 1.7% when using both stains.
  
  
  CONCLUSIONS
  The addition of toluidine blue increased the diagnostic accuracy of the trainee, and we encourage the use and teaching of this stain in Mohs surgery.
authors: University Hospital of Wales, Cardiff, UK. contact@hamidtehrani.com
authors: Hamid
authors: H
authors: Tehrani
authors: Kenneth
authors: K
authors: May
authors: Andrew
authors: A
authors: Morris
authors: Richard
authors: R
authors: Motley
mesh_terms: D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002983:Clinical Competence; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D005456:Fluorescent Dyes; D006416:Hematoxylin; D006801:Humans; D015580:Mohs Surgery / Q000193:education*; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014048:Tolonium Chloride
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes; D014048:Tolonium Chloride; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin