title: Fast evaluation of 69 basal cell carcinomas with ex vivo fluorescence confocal microscopy: criteria description, histopathological correlation, and interobserver agreement.
abstract: OBJECTIVE
  Fluorescence confocal microscopy (FCM) represents a first step toward a rapid "bedside pathology" in the Mohs surgery setting and in other fields of general pathology.
  
  
  OBJECTIVE
  To describe and validate FCM criteria for the main basal cell carcinoma (BCC) subtypes and to demonstrate the overall agreement with classic pathologic analysis of hematoxylin-eosin-stained samples. DESIGN A total of 69 BCCs from 66 patients were prospectively imaged using ex vivo FCM. Confocal mosaics were evaluated in real time and compared with classic pathologic analysis.
  
  
  METHODS
  Department of Dermatology, Hospital Clínic of Barcelona, Barcelona, Spain, between November 2010 and July 2011.
  
  
  METHODS
  Patients with BCC attending the Mohs Surgery Unit.
  
  
  METHODS
  Presence or absence of BCC and histological subtype (superficial, nodular, and infiltrating) in the confocal mosaics. Eight criteria for BCC were described, evaluated, and validated.
  
  
  RESULTS
  Although there were minor differences among BCC subtypes, the most BCC-defining criteria were peripheral palisading, clefting, nuclear pleomorphism, and presence of stroma. These criteria were validated with independent observers (κ values >0.7 [corrected] for most criteria).
  
  
  CONCLUSIONS
  We herein propose, describe, and validate FCM criteria for BCC diagnosis. Fluorescence confocal microscopy is an attractive alternative to histopathologic analysis of frozen sections during Mohs surgery because large areas of freshly excised tissue can be assessed in real time without the need for tissue processing while minimizing labor and costs.
authors: Department of Dermatology, Hospital Clínic and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain. tbennassar@gmail.com
authors: Antoni
authors: A
authors: Bennàssar
authors: Cristina
authors: C
authors: Carrera
authors: Susana
authors: S
authors: Puig
authors: Antoni
authors: A
authors: Vilalta
authors: Josep
authors: J
authors: Malvehy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D005453:Fluorescence; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D015580:Mohs Surgery; D015588:Observer Variation; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D060726:Torso