Using Frozen Sections for Primary Diagnosis of Skin Lesions?

I know many dermatologists are reading their own biopsies after sending the specimen off to a lab for processing and getting returned slides. What about using just a Mohs type (en face) or a 90 deg cross section type frozen section for primary diagnosis without subsequent permanent sections via routine processing?

Doctor Answers 5

Frozen sections for rapid diagnosis of skin conditions.

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As a board certfied dermatologist and Mohs surgeon, I have had a lot of experience looking at countless slides both via frozen section and via parafin block sections.  In many cases a quick  frozen section can be of benefit in an initial diagnosis but there are ultimately drawbacks with frozen sections.  Tissue cuts are thicker, so there is loss of cell clarity and many cells, particularly melanocytes, shrink away to the point of losing their morphology when the tissue is frozen first.  So bottom line,  frozens work well for a quick down and dirty assessment of a lesion, but not well on pigmented lesions nor on complicated inflammatory conditions. 

Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Using Frozen Sections for Primary Diagnosis of Skin Lesions?

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Thank you for your question. This varies from doctor to doctor, depending on dermatopathology training. Residency training programs may vary considerably in terms of histopathology training, and often Board Certified Dermatologists do not read their own slides for general dermatology diagnoses, and rather forward these on to dermatopathologists who do have formalized training in reading skin slides. I hope this helps.

Pathologic examination after skin cancer surgery - Los Angeles

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Pathologic diagnosis is essential and I send my specimens to a board certified dermatopathologist who specializes in skin cancer.  Raffy Karamanoukian, Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews


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Permanent sections are more reliable than frozen section.  Special stains can be used that are not available in frozen sections to ferret out the more difficult lesions.  Once a diagnosis is confirmed, then Mohs or wide excision with cross section frozen section control can be used as indicated in appropriate lesions.

Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Why are outside labs used in dermatology

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A couple things:

1. I agree with Dr. Swengel's statements about when and why these types of frozen section biopsies just don't make sense, or don't provide a clear enough view to give proper patient care and diagnosis.

2. Dermatology offices aren't set up to be labs. They can be set up to do Mohs, but that requires a specific set of dyes, and types of cuts and slides. A full lab set up takes an inordinate amount of space, and most dermatologists can't have that on site, not to mention they'd have to have a full-time histotech on staff to make the slides, on an off-chance that any patient may need that any day. It's not an ideal situation for space or staffing.

3. Dermatologists cannot bill for specific slides and cuts of slides. It's not under the proper coding, so to just do a frozen section, while we can bill for that, it's not always appropriate and no insurance company is going to want a bunch of frozen section codes coming from one physician's office, when it's much more ideal for the patient, the lab, and the billing, to come from an appropriate lab.

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