DS24 Prospective study comparing <i>ex vivo</i> confocal laser scanning microscopy and frozen section histopathology of 23 basal cell carcinomas treated with Mohs micrographic surgery

Abstract Ex vivo confocal laser scanning microscopy (CLSM) is an emerging technique that used for the rapid analysis of freshly excised tissue during Mohs micrographic surgery (MMS). Previous studies on fluorescence CLSM have shown 88% and 99% sensitivity specificity, respectively, diagnosing basal cell carcinomas (BCCs) vs. conventional histology. The fourth-generation Vivascope 2500 allows fresh to be scanned after minimal preparation with acetic acid acridine orange, creating digitally coloured mosaic images, mimicking histological haematoxylin eosin slides. speed &amp;lt; 3 min creates potential improve patient experiences, allowing multiple stages repair in a single session, reducing overall operating times improving efficiency. After 2018 pilot study limited case series, we begun process testing real-world use this technology. We present initial prospective series assess BCC excision stage 1 specimens using frozen section Caldicot approval was sought. Over 3-month period, 23 cases facial BCCs one list were processed. Samples obtained as standard bevelled excisions, maps created all cases. There three false-negative BCCs, which two infiltrative small foci missed review images superficial not visible due lack epidermal capture. Of four false-positive cases, appearing included inflammation one, follicular structures conjunctival glands misinterpreted eyelid case. Time taken read digital by compared time obtain shortest recorded sections 6 31 min, respectively. longest 20 57 In summary, shows promise MMS selected BCCs. Improved techniques flatten epidermis better visualization further experience image reading interpretation minimize errors.