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Intraoperative diagnosis of nonpigmented nail tumours with ex vivo fluorescence confocal microscopy: 10 cases
Author(s) -
Debarbieux S.,
Gaspar R.,
Depaepe L.,
Dalle S.,
Balme B.,
Thomas L.
Publication year - 2015
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.13384
Subject(s) - ex vivo , haematoxylin , medicine , pathology , basal cell carcinoma , histopathology , pagetoid , acridine orange , mohs surgery , melanoma , in vivo , confocal microscopy , basal cell , staining , immunohistochemistry , biology , microbiology and biotechnology , cancer research
Summary Background Ex vivo fluorescence confocal microscopy (FCM) permits real‐time imaging of freshly excised skin tissues. Its usefulness as a time‐sparing alternative to frozen sections in Mohs surgery of basal cell carcinoma is well documented. Objectives The purpose of this study was to describe the ex vivo FCM features of a series of benign and malignant nonpigmented tumours of the nail unit, and to correlate them with conventional histopathology. Patients and methods Nail apparatus tumours from 10 patients were imaged during surgical exploration using ex vivo FCM after immersion in acridine orange. Confocal mosaics of the freshly performed biopsies were evaluated in real time and retrospectively compared with haematoxylin and eosin sections. Results Our series included two invasive epithelial tumours (Group 1), four in situ or minimally invasive squamous cell carcinomas (SCC) (Group 2), three benign epithelial tumours (Group 3) and one nodular melanoma (Group 4). The correlation was excellent for malignant epithelial tumours exhibiting marked cytological and architectural atypias (Bowen disease, invasive SCC and onycholemmal carcinoma). Onychomatricomas exhibited a very peculiar aspect with densely cellular papillae. The correlation was less favourable for minimally invasive well‐differentiated SCCs with slight cytological atypias. The correlation was poor for our case of amelanotic invasive subungual melanoma. Conclusions Ex vivo FCM could be a useful tool to shorten management of nonpigmented nail tumours: in the case of a malignant tumour, it could indeed lead to performing wide excision during the same surgical procedure and possibly assessing the surgical margins.