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Immunostains

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Mohs Micrographic Surgery

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Abstract

Mohs micrographic surgery (MMS) is a frozen section technique well suited for removal of some of the more difficult cutaneous malignancies. The primary emphasis of the procedure is histologic examination of the entirety of surgical margins, which is done intraoperatively prior to wound closure. There are, on occasion, instances where the microscopic interpretation during Mohs is hindered by, dense inflammation abundant scar tissue, and additional cases where subtle perineural or skeletal muscle invasion may go undetected in frozen sections. For melanoma patients, the problem is difficulty in locating melanocytes on H & E stained frozen sections, especially for tumors that arise on chronically sun-damaged skin. Immunostains can be extremely helpful for visualizing tumor in frozen sections and are being used more frequently by Mohs surgeons when H & E alone is deemed insufficient. We intend to review the full spectrum of immunostaining techniques used in Mohs, many of which are simply modifications of immunoperoxidase protocols employed in permanent sections. A perceived drawback is the delay in surgery associated with tissue processing and the technical aspects of immunostaining. The time required to process each Mohs layer varies with the antibody, but many of the newer protocols require as little as 20 min to complete. Currently, immunostains are used during MMS for melanoma, basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, extramammary Paget’s disease, granular cell tumor, primary mucinous carcinoma, and trichilemmal carcinoma, and these immunostains are summarized in this chapter.

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Authors and Affiliations

  1. Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL, USA

    Kapila V. Paghdal, Basil S. Cherpelis & L. Frank Glass

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  1. Kapila V. Paghdal
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  2. Basil S. Cherpelis
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  3. L. Frank Glass
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Correspondence to Kapila V. Paghdal .

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Editors and Affiliations

  1. Miller School of Medicine, Dept. Dermatology, University of Miami, NW. 10th Ave. 1600, Miami, 33136, Florida, USA

    Keyvan Nouri

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Paghdal, K.V., Cherpelis, B.S., Glass, L.F. (2012). Immunostains. In: Nouri, K. (eds) Mohs Micrographic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-2152-7_15

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  • DOI: https://doi.org/10.1007/978-1-4471-2152-7_15

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