Toluidine Blue and Hematoxylin and Eosin Stains are Comparable in Evaluating Squamous Cell Carcinoma During Mohs.
BACKGROUND
Histologic examination of tissue is the foundation of Mohs micrographic surgery because determination of surgical margins influences whether additional tissue will be taken. Currently, there is no large focused study comparing toluidine blue (TB) and hematoxylin and eosin (H&E) stains in the evaluation of squamous cell carcinoma (SCC).


OBJECTIVE
This study evaluates whether TB and H&E are comparable in assessing the presence of tumor in frozen sections of SCC.


METHODS
One hundred eighty-six randomized slides representing 93 tissue pieces from 36 tumors were examined by 3 Mohs surgeons (1 Accreditation Council for Graduate Medical Education fellow and 2 fellowship-trained surgeons) and compared using a template that documented the presence and location of tumor on the slides.


RESULTS
The evaluation of SCC with H&E and TB stains was highly concordant, with concordant identification of SCC in 96%, 96%, and 94% of tissue layers among the 3 Mohs surgeons ARS, LHG, and AK-A, respectively.


CONCLUSIONS
Toluidine blue and H&E stains are statistically similar in their ability to detect SCC and guide Mohs surgical decision-making.
*Florida Dermatology and Skin Cancer Centers, Tamarac, Florida; †DermSurgery Associates, PA, Houston, Texas.
Andrew R
AR
Styperek
Leonard H
LH
Goldberg
Laura E
LE
Goldschmidt
Arash
A
Kimyai-Asadi
D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D005629:Frozen Sections; D006416:Hematoxylin; D006801:Humans; D015580:Mohs Surgery; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013194:Staining and Labeling / Q000379:methods*; D014048:Tolonium Chloride
D014048:Tolonium Chloride; D006416:Hematoxylin