Histopathology on Mohs surgery PDF
Preview Histopathology on Mohs surgery
MOHS SURGERY AND HISTOPATHOLOGY: BEYOND THE FUNDAMENTALS MOHS SURGERY is a highly effective technique for the surgical removal of most types of cutaneous and oral pharyngeal cancers. The procedure allows for the precise and complete removalofcancerswhilemaximizingthepreservationofsurroundingnormaltissue.Through the presentation and orientation of the specimens’ complete surgical margin on pathology slides,thelocationoftumorfociandotherrelevantfindingscanbecorrelatedwiththeirloca- tionsonthesurgicalwound.Theabilitytocreateperfectslidesforhistologicalexamination lies at the core of effective Mohs surgery. This procedure has the highest cure rate among alternative cancer treatment modalities for the cancers for which it is utilized. This book describes the methods the Mohs surgeon-pathologist and Mohs technician use to optimize the Mohs technique and produce the highest-quality slides and highest cure rates possible, anditbreaksnewgroundindescribingtechniquesthattheMohstechnicianusesinthelab. Ken Gross, MD, is non-salaried Clinical Professor in the Division of Dermatology at the University of California, San Diego School of Medicine, San Diego, and is also in private practicelimitedtothetreatmentofskincancerinSanDiego,California. HowardK.Steinman,MD,isDirectorofDermatologicandSkinCancerSurgeryandAsso- ciateProfessorof Dermatologyat the TexasA&M UniversityHealthSciencesCenter Col- legeofMedicine,ScottandWhiteMedicalCenter,Temple,Texas. Cambridge Books Online © Cambridge University Press, 2009 Cambridge Books Online © Cambridge University Press, 2009 MOHS SURGERY AND HISTOPATHOLOGY: BEYOND THE FUNDAMENTALS Edited by Ken Gross UniversityofCalifornia,SanDiegoSchoolofMedicine SanDiego,California Howard K. Steinman TexasA&MUniversityHealthSciencesCenterCollegeofMedicine Temple,Texas Cambridge Books Online © Cambridge University Press, 2009 CAMBRIDGEUNIVERSITYPRESS Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore,Sa˜oPaulo,Delhi CambridgeUniversityPress 32AvenueoftheAmericas,NewYork,NY10013-2473,USA www.cambridge.org Informationonthistitle:www.cambridge.org/9780521888042 (cid:1) C CambridgeUniversityPress2009 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2009 PrintedintheUnitedStatesofAmerica AcatalogrecordforthispublicationisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationdata Mohssurgeryandhistopathology:beyondthefundamentals/editedbyKenGross,HowardK.Steinman. p.; cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-88804-2(hardback) 1.Mohssurgery. 2.Skin–Histopathology. I.Gross,KennethG.(KennethGary),1943– II.Steinman, HowardK. III.Title. [DNLM:1.MohsSurgery–methods. 2.HistologicalTechniques–methods. 3.SkinNeoplasms– pathology. WR500H6732009] RD655.M647 2009 616.99(cid:2)477059–dc22 2008054112 ISBN 978-0-521-88804-2hardback CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyofURLsforexternalorthird- partyInternetWebsitesreferredtointhispublicationanddoesnotguaranteethatanycontentonsuchWeb sitesis,orwillremain,accurateorappropriate.Informationregardingprices,traveltimetables,andotherfactual informationgiveninthisworkarecorrectatthetimeoffirstprinting,butCambridgeUniversityPressdoesnot guaranteetheaccuracyofsuchinformationthereafter. Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawnfrom actualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,the authors,editors,andpublisherscanmakenowarrantiesthattheinformationcontainedhereinistotallyfreefrom error,notleastbecauseclinicalstandardsareconstantlychangingthroughresearchandregulation.Theauthors, editors,andpublishersthereforedisclaimallliabilityfordirectorconsequentialdamagesresultingfromtheuse ofmaterialcontainedinthisbook.Readersarestronglyadvisedtopaycarefulattentiontoinformationprovided bythemanufacturerofanydrugsorequipmentthattheyplantouse. Cambridge Books Online © Cambridge University Press, 2009 Ihopethisbookwilleventuallyfinditswaytothebookshelfequivalentofthe“dustbinofhistory,”as targetedimmunotherapyandotherevolvingcancertreatmentsreplacethesurgicalmodelemployedtoday. EvenaprocedureaselegantasMohssurgerywillfinditsrightfulplacealongsideotheroutdatedsurgical techniques.Ihopethetransformationhappensinmylifetime. ToRuthGrossandEdithChepin:twopeasinapodenjoyingtheirtenthdecadeoflife. KGG ToBarryGoldsmith,forpatientlyandthoughtfullyteachingmeMohssurgery. TothemanyMohssurgerycourseparticipantsforshowingmehowtobetterpracticeandteachourcraft. AndmostassuredlytoRobertandMadeline,nowgone,andDiedreandoursons,AdamandSteven,sine quanons,fortheirboundlesslove,encouragement,support,andhumor,whichgivesfoundation, perspective,joy,andcontentmenttomylife. HKS Ourdearfriendandcolleague,TerryO’Grady,whodiedduringthepreparationofthisbook, willbegreatlymissed. KGGandHKS Cambridge Books Online © Cambridge University Press, 2009 Cambridge Books Online © Cambridge University Press, 2009 Contents CONTRIBUTORS ix Chap.7.LABPEARLS:STAINING,INKING, ANDCOVERSLIPPING 57 PART I AlexLutz MICROSCOPYANDTISSUEPREPARATION 1 Chap.8.LABPEARLS:TROUBLESHOOTING Chap.1.INTRODUCTION 3 SLIDEQUALITY 62 KenGrossandHowardK.Steinman AlexLutz Chap.9.MOHSSLIDESORGANIZATIONAND Chap.2.HOWTOEXCISETISSUEFOROPTIMAL STANDARDIZATIONFOREFFECTIVE SECTIONING 5 INTERPRETATION 67 KenGross KenGross Chap.3.OPTIMIZINGTHEMOHS Chap.10.MOHSMAPPING 78 MICROSCOPE 15 HowardK.Steinman KenGross Chap.4.TISSUEPREPARATIONAND PART III CHROMACODING 21 MICROANATOMYANDNEOPLASTIC HowardK.Steinman DISEASE 83 Chap.5.EMBEDDINGTECHNIQUES 27 Chap.11.NORMALMICROANATOMY:VERTICAL EdwardH.Yob ANDHORIZONTAL 85 JohnB.Campbell PART II Chap.12.BASALCELLCARCINOMA:VERTICAL INTRODUCTIONTOLABORATORY ANDHORIZONTAL 96 TECHNIQUES 35 A.NeilCrowsonandCarlosGarcia AlexLutz Chap.13.SQUAMOUSCELLCARCINOMA: Chap.6.LABPEARLS:MAKINGGREAT VERTICALANDHORIZONTAL 109 SLIDES 37 A.NeilCrowsonandEdwardH.Yob AlexLutz Chap.14.UNUSUALTUMORS:VERTICALAND PREPARINGSLIDESWITHCARTILAGE 52 HORIZONTAL 118 MichaelShelton TerenceO’Grady vii Cambridge Books Online © Cambridge University Press, 2009 viii CONTENTS Chap.15.MOHSFORMELANOMA 129 Chap.19.TOLUIDINEBLUESTAINFORMOHS AdamJ.MamelakandArashKimyai-Asadi MICROGRAPHICSURGERY 155 OferArnon,AdamJ.Mamelak,andLeonardH.Goldberg Chap.16.TAKINGSTAGESBEYONDSTAGEI 138 TriH.Nguyen Chap.20.FORMSANDTEMPLATESFOR MOHSSURGERY 161 Chap.17.PERINEURALTUMORS 142 KenGrossandHowardK.Steinman AlexanderMiller INDEX 177 PART IV SPECIALTECHNIQUESANDSTAINS 149 Chap.18.FIXED-TISSUEMOHS 151 LauraT.Cepeda,DanielM.Siegel,and NormanA.Brooks Cambridge Books Online © Cambridge University Press, 2009 Contributors OferArnon,MD DivisionofDermatology DepartmentofPlasticandReconstructiveSurgery DepartmentofMedicine SorokaUniversityMedicalCenter UniversityofCalifornia,SanDiegoSchoolofMedicine Beer-Sheva,Israel SanDiego,California NormanA.Brooks,MD ArashKimyai-Asadi,MD SkinCancerMedicalCenter DermSurgeryAssociates Encino,California Houston,Texas AlexLutz JohnB.Campbell,MD TravelTechMohsServices,Inc. PacificPathology Torrance,California SanDiego,California AdamJ.Mamelak,MD LauraT.Cepeda,MD DepartmentofDermatology LongIslandSkinCancer&DermatologicSurgery TheMethodistHospital Smithtown,NewYork Houston,Texas A.NeilCrowson,MD AlexanderMiller,MD DepartmentsofDermatology,Pathology,andSurgery DepartmentofDermatology UniversityofOklahomaandRegionalMedical UniversityofCalifornia,Irvine Laboratories Irvine,California St.JohnMedicalCenter PrivatePractice,Dermatology Tulsa,Oklahoma YorbaLinda,California CarlosGarcia,MD TriH.Nguyen,MD DepartmentofDermatology DepartmentsofDermatologyandOtorhinolaryngology UniversityofOklahoma TheUniversityofTexasMDAndersonCancerCenter OklahomaCity,Oklahoma Houston,Texas † TerenceO’Grady,MD LeonardH.Goldberg,MD DivisionofDermatology DermSurgeryAssociates DepartmentofMedicine Houston,Texas UniversityofCalifornia SanDiegoSchoolofMedicine KenGross,MD SanDiego,California PrivatePractice,DermatologicSurgery SanDiego,California †deceased ix Cambridge Books Online © Cambridge University Press, 2009 x CONTRIBUTORS MichaelShelton EdwardH.Yob,DO SkinSurgeryMedicalGroup,Inc. DepartmentofDermatology SanDiego,California UniversityofOklahoma OklahomaCity,Oklahoma DanielM.Siegel,MD DermatologyAssociatesofTulsa,LLC LongIslandSkinCancer&DermatologicSurgery Tulsa,Oklahoma Smithtown,NewYork HowardK.Steinman,MD TexasA&MUniversityHealthScienceCenterCollege ofMedicine ScottandWhiteMedicalCenter Temple,Texas Cambridge Books Online © Cambridge University Press, 2009
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