From the Guidelines
Frozen section analysis of skin Paget's disease samples during surgery is not recommended as the primary diagnostic approach. The histopathological features of Paget's disease can be difficult to accurately identify on frozen sections due to freezing artifacts and processing limitations 1. Permanent sections with special stains and immunohistochemistry are typically required for definitive diagnosis. Some key points to consider include:
- The challenges with frozen section diagnosis, such as potential false negatives due to the scattered nature of Paget cells within the epidermis
- Difficulty distinguishing Paget cells from melanocytes or inflammatory cells
- The underlying invasive component that may accompany Paget's disease could be missed on frozen section. If intraoperative margin assessment is necessary, it's preferable to use techniques like Mohs micrographic surgery with fixed tissue processing rather than frozen sections, as seen in the management of other skin cancers like basal cell carcinoma 1. Final management decisions should generally be based on permanent section histopathology rather than intraoperative frozen section diagnosis.
From the Research
Skin Paget's Disease Samples for Frozen Sections
- Skin Paget's disease samples can be sent for frozen sections intraoperatively, as evidenced by studies that utilized intraoperative frozen-section analysis to guide wide local excision in the treatment of penoscrotal extramammary Paget's disease 2, 3, 4.
- The use of intraoperative frozen biopsy or preoperative mapping biopsy has been shown to be beneficial in achieving negative margins and reducing the risk of recurrence 3, 4.
- A rapid mucin staining technique can be used on frozen sections to aid in the diagnosis of extramammary Paget disease, with a staining time of 3 minutes or less 5.
- The importance of intraoperative frozen-section analysis is highlighted by the fact that it can help reduce the risk of incomplete resection and recurrence, with one study showing a reduced recurrence rate of 25% compared to 60% with simple wide local excision 4.
Benefits and Limitations
- Intraoperative frozen-section analysis can provide valuable information to guide surgical excision and reduce the risk of recurrence.
- However, it is not foolproof, and false-negative results can occur, as seen in one study where five patients had false-negative results 2.
- The use of intraoperative frozen biopsy or preoperative mapping biopsy cannot guarantee negative margins on final pathology, but it can help improve outcomes 3.