A Review of the Use of Ex-Vivo Confocal Microscopy in the Management of Non-Melanoma Skin Cancers

BACKGROUND: Patients with nonmelanoma skin cancers often undergo Mohs Micrographic Surgery to preserve normal tissue. With technological advancements, ex vivo confocal microscopy allows for an increase in precision due to its fast, high-resolution imaging of freshly excised tissues. OBJECTIVE: We plan to evaluate the clinical utilization, performance, and advantages of ex vivo confocal microscopy for the assessment of nonmelanoma skin cancers during Mohs micrographic surgery. METHODS: A literature search was conducted using the PubMed, MEDLINE, and Embase databases using combinations of the following key terms: "ex vivo confocal microscopy," "fluorescence confocal microscopy," "reflectance confocal microscopy," "Mohs surgery," "nonmelanoma skin cancer," and "margin assessment." Studies were included if they were published in English and included original patient-level data or diagnostic performance metrics relevant to ex vivo confocal microscopy in Mohs micrographic surgery. RESULTS: Ex vivo confocal microscopy demonstrated a high diagnostic accuracy for margin assessment of nonmelanoma skin cancers, reducing tissue processing and interpretation times, often to under 15 minutes, compared with traditional frozen section histology. Limitations included reduced sensitivity in certain aggressive tumor subtypes and equipment costs. CONCLUSION: Ex vivo confocal microscopy during Mohs micrographic surgery allows for an enhancement in procedural outcome due to its high diagnostic accuracy and ability to reduce operative time.