Comparison of ex vivo optical coherence tomography with conventional frozen-section histology for visualizing basal cell carcinoma during Mohs micrographic surgery

Background Mohs micrographic surgery offers high cure rates of nonmelanoma skin cancers with optimal sparing of normal tissue. However, it is generally more time-consuming and labour-intensive than traditional surgery. Optical coherence tomography (OCT) is an emergent technology that has the potential to diagnose basal cell carcinoma (BCC) in vivo. Objective To compare the efficiency and accuracy of ex vivo OCT with frozen-section histology for identifying BCC in Mohs surgery. Methods Thirty-eight patients were enrolled. After the stages were taken, images were captured with an OCT microscope and subsequently processed for standard frozen sections. Results In total, 75 sections were scanned and the mean time to produce one OCT image was 7 min. In four of 26 positive haematoxylin-eosin sections and 23 of 49 negative sections, there was a good correlation with OCT images. The sensitivity and specificity were 19% and 56%, respectively. Conclusions It is possible to identify BCC with ex vivo OCT and this is more rapidly obtained than with haematoxylin-eosin frozen sections. However, tumour visualization in OCT was disappointing. Practical benefit may be obtained by optimizing this technology and combining it with other new diagnostic tools.