Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer

Murad Alam*, Misbah Khan, Emir Veledar, Marisa Pongprutthipan, Arthur Flores, Meghan Dubina, Michael Nodzenski, Simon S Yoo

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed onMay 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For eachwedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82%to 96%. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

Original languageEnglish (US)
Pages (from-to)173-176
Number of pages4
JournalJAMA dermatology
Volume152
Issue number2
DOIs
StatePublished - Feb 1 2016

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Frozen Sections
Skin Neoplasms
Inflammation
Neoplasms
Mohs Surgery
Medical Records
Squamous Cell Carcinoma
Cohort Studies
Retrospective Studies
Carcinoma

ASJC Scopus subject areas

  • Dermatology

Cite this

Alam, Murad ; Khan, Misbah ; Veledar, Emir ; Pongprutthipan, Marisa ; Flores, Arthur ; Dubina, Meghan ; Nodzenski, Michael ; Yoo, Simon S. / Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer. In: JAMA dermatology. 2016 ; Vol. 152, No. 2. pp. 173-176.
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title = "Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer",
abstract = "IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed onMay 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For eachwedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65{\%}) were b asal cel carcinoma and 21 (35{\%}) were squamous cell carcinomas; 53 (88{\%}) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91{\%}, with segment-specific probability values ranging from 82{\%}to 96{\%}. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.",
author = "Murad Alam and Misbah Khan and Emir Veledar and Marisa Pongprutthipan and Arthur Flores and Meghan Dubina and Michael Nodzenski and Yoo, {Simon S}",
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Alam, M, Khan, M, Veledar, E, Pongprutthipan, M, Flores, A, Dubina, M, Nodzenski, M & Yoo, SS 2016, 'Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer', JAMA dermatology, vol. 152, no. 2, pp. 173-176. https://doi.org/10.1001/jamadermatol.2015.3649

Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer. / Alam, Murad; Khan, Misbah; Veledar, Emir; Pongprutthipan, Marisa; Flores, Arthur; Dubina, Meghan; Nodzenski, Michael; Yoo, Simon S.

In: JAMA dermatology, Vol. 152, No. 2, 01.02.2016, p. 173-176.

Research output: Contribution to journalArticle

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T1 - Correlation of inflammation in frozen sections with site of nonmelanoma skin cancer

AU - Alam, Murad

AU - Khan, Misbah

AU - Veledar, Emir

AU - Pongprutthipan, Marisa

AU - Flores, Arthur

AU - Dubina, Meghan

AU - Nodzenski, Michael

AU - Yoo, Simon S

PY - 2016/2/1

Y1 - 2016/2/1

N2 - IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed onMay 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For eachwedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82%to 96%. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

AB - IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed onMay 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For eachwedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82%to 96%. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

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