Real-time ex-vivo assessment of basal cell carcinoma surgical margins in Mohs surgery by autofluorescence-Raman spectroscopy: a pilot study

Boitor, Radu; Varma, V; Sharma, A; Elsheikh, S; Kulkarni, K; Eldib, K; Jerrom, R; Odedra, S; Patel, A; Koloydenko, A; Williams, H; Notingher, Ioan

Abstract

Background
Autofluorescence (AF)-Raman spectroscopy is a technology that can detect tumour tissue in surgically excised skin specimens. The technique does not require tissue fixation, staining, labelling or sectioning, and provides quantitative diagnosis maps within 30 minutes.
Objectives
To explore the clinical application of AF-Raman microscopy to detect residual basal cell carcinoma (BCC) positive margins in ex-vivo skin specimens excised during real-time Mohs surgery. To investigate the ability to analyse skin specimens from different parts of the head-and-neck areas and detect nodular, infiltrative and superficial BCC.
Methods
Fifty Mohs tissue layers (50 patients) were investigated: 27 split samples (two halves) and 23 full-face samples. The AF-Raman results were compared to frozen section histology, carried out intra-operatively by the Mohs surgeon and post-operatively by dermato-pathologists. The latter was used as the standard of reference.
Results
The AF-Raman analysis was completed within the target time of 30 minutes and was able to detect all sub-types of BCC. For the split specimens, the AF-Raman analysis covered 97% of the specimen surface area and detected 8 out of 9 BCC positive layers (similar to Mohs surgeons). For the full-face specimens, poor contact between tissue and cassette coverslip led to lower coverage of the specimen surface area (92%), decreasing the detection rate (4 out of 6 positives for BCC).
Conclusions
These preliminary results for the split specimens demonstrate the feasibility of AF-Raman microscopy for rapid assessment of Mohs layers for BCC presence. However, for full-face specimens, further work is required to improve the contact between the tissue and the coverslip to increase sensitivity.

Citation

Boitor, R., Varma, V., Sharma, A., Elsheikh, S., Kulkarni, K., Eldib, K., Jerrom, R., Odedra, S., Patel, A., Koloydenko, A., Williams, H., & Notingher, I. (in press). Real-time ex-vivo assessment of basal cell carcinoma surgical margins in Mohs surgery by autofluorescence-Raman spectroscopy: a pilot study. Journal of the European Academy of Dermatology and Venereology,

• Journal Article Type: Article
• Acceptance Date: Nov 8, 2023
• Deposit Date: Dec 15, 2023
• Journal: Journal of the European Academy of Dermatology and Venereology
• Print ISSN: 0926-9959
• Electronic ISSN: 1468-3083
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Keywords: Basal cell carcinoma; Mohs surgery; Raman spectroscopy; Intraoperative
• Public URL: https://nottingham-repository.worktribe.com/output/28433329
• Additional Information: Data availability statement: All data recorded is available upon request from the corresponding author. Ethics statement: Ethical approval was granted by the Health Research Authority (HRA) and Health and Care Research Wales (HCRW) (18/WM/0105) and informed consent was obtained from all recruited patients.