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Bone tumors are very rare and this is the reason why frozen section diagnosis is often difficult. The orthopedic surgeon wants to know the intraoperative diagnosis of biopsies of benign or malignant bone tumors so that definitive treatment can be carried out immediately in cases of diagnostic certainty. Diagnostic problems not only concern the distinction of benign and malignant tumors but also differentiation of a neoplastic from a reactive process. Clinical information is very important and all patients with bone tumors are discussed before surgical treatment in an interdisciplinary tumor board. Internationally but with the exception of the USA, the diagnostic procedure using frozen sections is not commonly used even in specialized centers.

Background: Immunohistochemistry (IHC) applied to Mohs micrographic surgery (MMS) is time consuming and labor intensive, and the variability of staining quality has prevented its widespread use in clinical practice., Objective: To investigate the readability of immunostains processed by a novel automated 16-minute technique used for evaluation of frozen sections prepared during MMS for melanoma., Methods: A rapid automated instrument that performs MART-1 (melanoma antigen recognized by T cells) immunostains in 16 minutes was used to stain frozen sections and was compared with MART-1 stains of paraffin (permanent) sections, hematoxylin-eosin (H&E) stains of frozen and permanent sections from the positive or negative control specimens of the Mohs layers for melanoma. A total of 480 interpretations from 48 sections (4 types of stains for each specimen, 12 specimens read by 10 interpreters) were analyzed via blinded examination by 5 dermatopathologists and 5 Mohs surgeons at two institutions. A scoring system was used to assess the readability of each slide. Analysis of variance was used for statistical analysis., Results: In terms of clarity of interpreting melanoma sections, the 16-minute MART-1 IHC of frozen sections is equivalent to the standard MART-1 of permanent sections. The 16-minute MART-1 sections are also significantly easier to interpret than permanent sections stained with H&E for both the dermatopathologists and Mohs surgeons (P < .05)., Limitations: The study represents data collected from only two institutions in the United States., Conclusion: The rapid-stained frozen IHC sections are significantly easier to interpret than the "gold standard" permanent sections stained with H&E. This technology facilitates the rapid interpretation of melanoma in frozen sections., (Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: For dermatologists the preparation of frozen sections means micrographic surgery. The preparation of frozen sections is meant to be rapid, but has multiple, discrete steps that demand attention to detail., Objective: The objective was to summarize both the proven and the cutting-edge techniques of frozen section preparation., Materials and Methods: Reports from the medical literature were used to augment techniques used in our practices., Conclusion: We dissect each step of micrographic cancer removal, report on the standard and preferred methods of tissue preparation, and summarize the progress achieved in the past decade.

Introduction: To assess laparoscopic management of presumed stage I endometrial cancer, and to compare gross, frozen, and paraffin section methods measuring myoinvasion., Patients and Methods: Eligible patients underwent laparoscopic exploration. Patients with preoperative grade 1 histology underwent laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVHBSO). Pelvic and periaortic lymph node sampling (PPANS) was performed for deep (> or =50%) myoinvasion confirmed by frozen section. Patients with preoperative grade 2 or 3 histology without evidence of extrauterine metastasis underwent PPANS + LAVHBSO., Results: Of 50 eligible patients selected, LAVHBSO was successfully completed in all but five. There was one trocar bowel perforation. Myoinvasion depth was correlated between paraffin section and gross estimate, and between paraffin and frozen section estimate, in 89 and 90% of cases, respectively. Myoinvasion was underestimated by gross versus paraffin in three of five discrepancies, and by frozen versus paraffin section in one of three discrepancies., Conclusions: Laparoscopic surgical staging for early stage endometrial cancer is feasible. Gross/frozen section methods correlate with paraffin section to measure myoinvasion. Tumor grading and gross/frozen section myoinvasion estimates can guide operative management.

Objectives: To compare a rapid, cross-sectional frozen-section technique with Mohs micrographic surgery, using recurrence rate and cost of treatment for excision of basal cell carcinoma as indicators to validate our indications for Mohs surgery., Design: Retrospective study of 557 head and neck basal cell carcinomas excised over 10 years., Main Outcome Measures: Recurrence rates; tumor comparisons by size, location, and subtype; a life table, and a patient satisfaction survey., Results: Recurrence rate for the cross-sectional technique was 2.1% at 5 years. Recurrent tumors had an average diameter of 1.56 cm (vs 1.04 cm for nonrecurrent tumors). Recurrences were in the cheek (30%), nose (20%), temple (20%), forehead/brow (10%), conchal bowl (10%), and postauricular crease (10%). Recurrences were nodular cystic (40%), micronodular (20%), multifocal (10%), and infiltrating (30%). A total of 86.6% of patients surveyed rated the aesthetic outcome of their surgery favorably. The cost compared with the cost of Mohs excision varied depending on the Current Procedural Terminology coding technique., Conclusions: Cross-sectional frozen-section recurrence rates can compare favorably with Mohs micrographic surgery. The cross-sectional frozen-section technique generated a cost savings over Mohs surgery that may not hold true for all practice settings. Margin size did not adversely affect aesthetic results. Loupe magnification x2.5 is important in our technique. We also offer a useful definition for recurrence.