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

Radu Boitor, S. Varma, A Sharma, S Elsheikh, Kusum Kulkarni, K Eldib, R Jerrom, S Odedra, A Patel, Alexey Koloydenko, Hywel Williams, Ioan Notingher

Research output: Contribution to journalArticlepeer-review


Autofluorescence (AF)-Raman spectroscopy is a technique 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.
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 the BCC subtypes (nodular, infiltrative and superficial BCC).
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.
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 the Mohs
surgeons). For the full-face specimens, poorer contact between tissue and cassette coverslip led
to lower analysis coverage of the specimen surface area (92%), decreasing the detection rate
(4 out of 6 positives for BCC).
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.
Original languageEnglish
Pages (from-to)498-507
Number of pages10
JournalJournal of the European Academy of Dermatology and Venerology
Issue number2
Early online date14 Dec 2023
Publication statusPublished - 4 Jun 2024

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