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Immunostaining Advances Up Melanocyte ID Efficiency
ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.
Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.
The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.
"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."
One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.
A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.
Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.
Dr. Cherpelis and his colleagues have streamlined the process.
"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.
MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.
Dr. Cherpelis said he had no relevant financial disclosures.
ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.
Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.
The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.
"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."
One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.
A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.
Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.
Dr. Cherpelis and his colleagues have streamlined the process.
"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.
MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.
Dr. Cherpelis said he had no relevant financial disclosures.
ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.
Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.
The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.
"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."
One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.
A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.
Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.
Dr. Cherpelis and his colleagues have streamlined the process.
"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.
MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.
Dr. Cherpelis said he had no relevant financial disclosures.
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Blog: Top 10 Reasons to Embrace Chemical Peels
The power of the chemical peel should not be underestimated, according to Dr. M. Elizabeth Briden, medical director of the Advanced Dermatology & Cosmetic Institute in Edina, Minn., and adjunct associate professor at the University of Minnesota, Minneapolis.
Glycolic acid peels are especially appropriate for uncertain times because of their versatility. At the Orlando Dermatology Aesthetic & Clinical Conference, Dr. Briden shared her top 10 reasons to use glycolic acid peels:
10. People like them, they really like them. In 2009, approximately half a million chemical peels were performed in the U.S., according to the American Society of Plastic Surgeons. Okay, so there were more than 2 million botulinum toxin injections and more than 1 million filler procedures, but patients obviously haven't given up on peels.
9. Glycolic acid peels are green. Glycolic acid consists of organic carboxylic acid and sugar cane. It doesn't get much more natural than that, and a "green" peel has appeal for many patients.
8. Glycolic acid peels are for everyone! Data support the use of glycolic acid peels on all skin types and all areas of the body, including the face, neck, chest, back, and even the hands and feet.
7. Glycolic acid peels are unique. The unique mechanism of action of glycolic acid works on the ionic bonds that hold skin cells together, so there is no tissue necrosis.
6. Glycolic acid peels are multitaskers. With glycolic acid peels, multiple depths of penetration are possible, and these peels have demonstrated beneficial effect on both the dermis and epidermis.
5. Glycolic peels offer a range of clinical and therapeutic benefits. They can improve the appearance of patients suffering from conditions including acne, rosacea, dyschromias, actinic keratoses, keratosis pilaris, and seborrheic keratoses.
4. Glycolic acid peels can help make patient look younger. Data support the effectiveness of glycolic acid for skin rejuvenation.
3. Glycolic acid peels are cooperative. The most popular skin rejuvenation procedures, including botulinum toxin injections, fillers, nonablative resurfacing, and cosmetic surgery, do not improve the surface of the skin. But glycolic acid peels can be used in addition to any of these treatments to complete your patient's improved appearance.
2. Glycolic acid peels are your surgical assistants. Peels can be used to prepare the skin before surgical or laser procedures and they can help maintain the rejuvenating effects after the procedures.
1. Glycolic peels are cost effective! These peels require minimal equipment, and they can be performed by ancillary staff members. They are affordable for patients, and they can serve as an introduction to skin rejuvenation treatments.
Dr. Briden disclosed serving as a consultant for NeoStrata.
Happy peeling!
–Heidi Splete (on Twitter @hsplete)
The power of the chemical peel should not be underestimated, according to Dr. M. Elizabeth Briden, medical director of the Advanced Dermatology & Cosmetic Institute in Edina, Minn., and adjunct associate professor at the University of Minnesota, Minneapolis.
Glycolic acid peels are especially appropriate for uncertain times because of their versatility. At the Orlando Dermatology Aesthetic & Clinical Conference, Dr. Briden shared her top 10 reasons to use glycolic acid peels:
10. People like them, they really like them. In 2009, approximately half a million chemical peels were performed in the U.S., according to the American Society of Plastic Surgeons. Okay, so there were more than 2 million botulinum toxin injections and more than 1 million filler procedures, but patients obviously haven't given up on peels.
9. Glycolic acid peels are green. Glycolic acid consists of organic carboxylic acid and sugar cane. It doesn't get much more natural than that, and a "green" peel has appeal for many patients.
8. Glycolic acid peels are for everyone! Data support the use of glycolic acid peels on all skin types and all areas of the body, including the face, neck, chest, back, and even the hands and feet.
7. Glycolic acid peels are unique. The unique mechanism of action of glycolic acid works on the ionic bonds that hold skin cells together, so there is no tissue necrosis.
6. Glycolic acid peels are multitaskers. With glycolic acid peels, multiple depths of penetration are possible, and these peels have demonstrated beneficial effect on both the dermis and epidermis.
5. Glycolic peels offer a range of clinical and therapeutic benefits. They can improve the appearance of patients suffering from conditions including acne, rosacea, dyschromias, actinic keratoses, keratosis pilaris, and seborrheic keratoses.
4. Glycolic acid peels can help make patient look younger. Data support the effectiveness of glycolic acid for skin rejuvenation.
3. Glycolic acid peels are cooperative. The most popular skin rejuvenation procedures, including botulinum toxin injections, fillers, nonablative resurfacing, and cosmetic surgery, do not improve the surface of the skin. But glycolic acid peels can be used in addition to any of these treatments to complete your patient's improved appearance.
2. Glycolic acid peels are your surgical assistants. Peels can be used to prepare the skin before surgical or laser procedures and they can help maintain the rejuvenating effects after the procedures.
1. Glycolic peels are cost effective! These peels require minimal equipment, and they can be performed by ancillary staff members. They are affordable for patients, and they can serve as an introduction to skin rejuvenation treatments.
Dr. Briden disclosed serving as a consultant for NeoStrata.
Happy peeling!
–Heidi Splete (on Twitter @hsplete)
The power of the chemical peel should not be underestimated, according to Dr. M. Elizabeth Briden, medical director of the Advanced Dermatology & Cosmetic Institute in Edina, Minn., and adjunct associate professor at the University of Minnesota, Minneapolis.
Glycolic acid peels are especially appropriate for uncertain times because of their versatility. At the Orlando Dermatology Aesthetic & Clinical Conference, Dr. Briden shared her top 10 reasons to use glycolic acid peels:
10. People like them, they really like them. In 2009, approximately half a million chemical peels were performed in the U.S., according to the American Society of Plastic Surgeons. Okay, so there were more than 2 million botulinum toxin injections and more than 1 million filler procedures, but patients obviously haven't given up on peels.
9. Glycolic acid peels are green. Glycolic acid consists of organic carboxylic acid and sugar cane. It doesn't get much more natural than that, and a "green" peel has appeal for many patients.
8. Glycolic acid peels are for everyone! Data support the use of glycolic acid peels on all skin types and all areas of the body, including the face, neck, chest, back, and even the hands and feet.
7. Glycolic acid peels are unique. The unique mechanism of action of glycolic acid works on the ionic bonds that hold skin cells together, so there is no tissue necrosis.
6. Glycolic acid peels are multitaskers. With glycolic acid peels, multiple depths of penetration are possible, and these peels have demonstrated beneficial effect on both the dermis and epidermis.
5. Glycolic peels offer a range of clinical and therapeutic benefits. They can improve the appearance of patients suffering from conditions including acne, rosacea, dyschromias, actinic keratoses, keratosis pilaris, and seborrheic keratoses.
4. Glycolic acid peels can help make patient look younger. Data support the effectiveness of glycolic acid for skin rejuvenation.
3. Glycolic acid peels are cooperative. The most popular skin rejuvenation procedures, including botulinum toxin injections, fillers, nonablative resurfacing, and cosmetic surgery, do not improve the surface of the skin. But glycolic acid peels can be used in addition to any of these treatments to complete your patient's improved appearance.
2. Glycolic acid peels are your surgical assistants. Peels can be used to prepare the skin before surgical or laser procedures and they can help maintain the rejuvenating effects after the procedures.
1. Glycolic peels are cost effective! These peels require minimal equipment, and they can be performed by ancillary staff members. They are affordable for patients, and they can serve as an introduction to skin rejuvenation treatments.
Dr. Briden disclosed serving as a consultant for NeoStrata.
Happy peeling!
–Heidi Splete (on Twitter @hsplete)