Mohs surgery of eyelid tumours assisted by ex vivo confocal microscopy and a new “open book” method for tissue preparation

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Abstract

Purpose

The micrographic Mohs surgery, that allows a complete and tissue-economic resection of skin tumours, is particularly adapted to eyelid margin tumours (EMT) surgery. However, being time consuming for pathologists it is not used in routine. Aim: to expose a fast and reproducible method of Mohs surgery for EMT associating ex vivo confocal microscopy (EVCM) and an original tissue preparation named “open-book”

Methods

EMT were surgically resected, let unfixed and unstained, immediately prepared with the “open book” technique and analysed with EVCM (vivascope 2500, Lucid Inc, NY and MAVIGH GmbH, Germany). The “open book” technique consisted of splitting the eyelid in two lamellae maintained by a hinge situated at the eyelid margin and flat-mounting it between two glass slides in order to allow acquisition of both cutaneous and conjunctival sides in the same EVCM scans. The whole sample volume was scanned at the 3 wavelengths available (488, 658 and 785 nm) and the mosaics was automatically reconstituted by the built-in software. Tumours were then immediately fixed in 4% PFA and a classical pathologic analysis was performed. Agreement between tumour limits found in EVCM analysis and in classical pathology was calculated with weighted kappa coefficient

Results

In all cases, the skin and conjunctival tumours limits determined by EVCM were comparable to classical pathology

Conclusion

ECVM combined with original “open book” tissue preparation could take a place in routine of eyelid tumour surgery. Grant: GIRCI jeune chercheur Rhone Alpes Auvergne 2013 No financial interest for all authors

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