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Published on: August 18, 2023
Immunostaining in Mohs micrographic surgery: a review
Abdel Kader El Tal1, Ayad E Abrou, Mark A Stiff
1Dermatology Department, Wayne State University, Dearborn, Michigan, USA.
Background:
With the advent of incorporating the immunoperoxidase staining technique into the processing of frozen tissue, the use of Mohs micrographic surgery (MMS) has been expanded to include several high-risk tumors such as lentigo maligna, malignant melanoma, and dermatofibrosarcoma protuberans.
Objectives:
To thoroughly review the English medical literature pertaining to the use of immunohistochemical staining techniques on frozen sections during MMS and to summarize the basic relevant outcomes from the different relevant studies.
Materials And Methods:
Medline search was conducted, with the following words used in the search criteria: "Mohs surgery,""staining,""immunostaining," and "immunoperoxidase." RESULTS Generally, all immunostains showed advantage over the traditional hematoxylin and eosin approach. Studies of MART-1 in melanoma chemosurgery indicated that it is typically crisp and has less background staining than MEL-5 and better staining consistency than HMB-45. In cases of desmoplastic melanomas, S100 is the stain of choice.
Conclusion:
Immunostaining offers an advantage in MMS. Large, randomized, prospective studies comparing the different immunostains are still lacking in the literature. The authors have indicated no significant interest with commercial supporters.
Insights
Immunohistochemical staining techniques enhance Mohs micrographic surgery (MMS) for high-risk skin cancers. These methods offer advantages over traditional staining for diagnosing tumors like melanoma.
Area of Science:
- Dermatology
- Surgical Pathology
- Oncology
Background:
- Immunoperoxidase staining integration expands Mohs micrographic surgery (MMS) applications.
- High-risk tumors like lentigo maligna, melanoma, and dermatofibrosarcoma protuberans are now candidates for MMS.
- Frozen tissue processing benefits from advanced staining techniques.
Purpose of the Study:
- Review English literature on immunohistochemical staining in MMS.
- Summarize outcomes of using frozen section immunostaining during MMS.
- Evaluate the efficacy of various staining techniques in MMS.
Main Methods:
- Conducted a Medline search using keywords: "Mohs surgery," "staining," "immunostaining," and "immunoperoxidase."
- Analyzed studies comparing immunohistochemical stains with traditional hematoxylin and eosin.
- Evaluated specific stains like MART-1, MEL-5, HMB-45, and S100 for melanoma and desmoplastic melanoma.
Main Results:
- Immunostains generally outperform traditional hematoxylin and eosin in MMS.
- MART-1 shows crisp staining with less background than MEL-5 for melanoma.
- S100 is the preferred stain for desmoplastic melanomas.
Conclusions:
- Immunostaining provides significant advantages in Mohs micrographic surgery.
- Further large, randomized, prospective studies comparing immunostains are needed.
- No commercial conflicts of interest were reported by the authors.
