title: Rapid Lump Examination as a New Aid to Speedup Mohs Micrographic Surgery: A Pilot Study.
abstract: BACKGROUND
  Although most cases of basal cell carcinoma (BCC) are curable, facial and recurrent BCCs require time consuming and labor-intensive Mohs micrographic surgery (MMS) to ensure complete removal with optimal cosmetic results. To handle the skin cancer epidemic, there is an urgent need to speedup MMS. Recently, rapid lump examination (RLE) has been shown to enable quick histologic examination, but its usefulness within MMS is unknown.
  
  
  OBJECTIVE
  To evaluate the accuracy of RLE for the detection of residual BCC during MMS.
  
  
  METHODS
  Twenty-two BCCs of various subtypes were evaluated by means of RLE and standard fresh frozen section (FFS) examination. For RLE, the freshly excised tissue was stained with toluidine blue and imaged with a stereomicroscope before being subdivided into sections suitable for processing into FFS. Fresh frozen sections were stained with hemotoxylin and eosin and evaluated with light microscopy.
  
  
  RESULTS
  Using FFS examination as the gold standard for the detection of residual BCC, RLE had a sensitivity, specificity, positive predictive value, and negative predictive value of 83.8%, 94.0%, 83.8%, and 94.0%, respectively.
  
  
  CONCLUSIONS
  As RLE enables quick 3-dimensional visualization of surgical margins for the detection of residual BCC, it holds the potential to speedup histologic examination during MMS.
authors.affiliation: *Mohs Klinieken Eindhoven, Eindhoven, the Netherlands; †Universitäts-Hautklinik Tübingen, Tübingen, Germany; ‡Praxisklinik Tübingen-Haut und Venen, Dr. A. Bern und Prof. Dr. M. Möhrle, Tübingen, Germany.
authors.forename: Marleen
authors.initials: M
authors.lastname: Veenstra
authors.forename: Judith
authors.initials: J
authors.lastname: Ostertag
authors.forename: Marc
authors.initials: M
authors.lastname: Verhaegh
authors.forename: Nils
authors.initials: N
authors.lastname: Nuessle
authors.forename: Matthias
authors.initials: M
authors.lastname: Moehrle
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005153:Facial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010865:Pilot Projects; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D013194:Staining and Labeling; D013997:Time Factors; D016896:Treatment Outcome