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Skin Cancer and the Frozen Section Histology Procedure

Updated on January 10, 2014
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Chris has spent 26 years in laboratory work and has had personal experience with cancer, alcoholism and Willis-Eckbom Disease (RLS).

A red, ulcerated lesion surrounded by a white border on the skin of the right ear. Ulcerated basal cell carcinoma with characteristic pearly rim.
A red, ulcerated lesion surrounded by a white border on the skin of the right ear. Ulcerated basal cell carcinoma with characteristic pearly rim. | Source

Common Skin Cancers

Skin cancer is reportedly on the rise in the United States. The two types of skin cancer which are most predominant are basal cell carcinoma and squamous cell carcinoma. Basal cell accounts for 90% of all skin cancer. These two types of skin cancer, while serious, are very treatable when discovered and treated early. A third type of skin cancer, and by far the most deadly, is melanoma. Basal cell carcinomas can appear anywhere on the body, but typically they show up in one or more of the following places:

Head
Face
Neck
Hands
Arms.

Cryostat, used for frozen sections

Frozen specimen in cryostat to the left or the white X, ready to be cut.
Frozen specimen in cryostat to the left or the white X, ready to be cut. | Source
Histology technician dipping slides in eosin and hematoxylin staining solutions.
Histology technician dipping slides in eosin and hematoxylin staining solutions. | Source
Pathologist reading frozen section slide prior to calling the surgeon with malignancy and margin status of the specimen.
Pathologist reading frozen section slide prior to calling the surgeon with malignancy and margin status of the specimen. | Source

The Frozen Section Histology Procedure

I have worked in a histology laboratory for twelve years as a histology technician. This is the department which performs a procedure called the frozen section or cryosection. When a person comes to the hospital to have a lesion removed, the surgeon quite often will send the specimen to the laboratory for immediate analysis during the surgical procedure. Here is a step by step description of the frozen section procedure that occurs as the surgeon, surgical staff and patient wait in the procedure room.

  1. The specimen is delivered to the histopathology department.
  2. The specimen is properly identified and the patient information is entered into the patient’s computer file.
  3. The specimen is given to a pathologist or pathology assistant.
  4. The tumor is located in the specimen.
  5. Piece(s) of the specimen suspected of containing tumor are cut to be used for obtaining frozen sections.
  6. The histology technician places the tissue onto a small metal disc with a viscous medium.
  7. The tissue and metal disc are placed in a cryostat to freeze at -20 to -30 degrees Celsius (-4 to -22F).
  8. The frozen tissue is placed on a cutting instrument in the cryostat called a microtome.
  9. A five micrometer thin cross section or frozen section of tissue is cut and placed onto a glass slide.
  10. The slide is dipped into various reagents including eosin dye which stains the cell cytoplasm pink and hematoxylin which stains the nucleus deep blue.
  11. A cover slip is placed on the slide, over the tissue.
  12. The pathologist looks at the tissue under a microscope to determine malignancy and to see if the margins of the tissue are clear of cancer cells.
  13. The p[athologist reports findings to the surgeon in the operating room via phone and intercom.
  14. If margins are not clear, the frozen section procedure is repeated on new tissue provided by the surgeon.

Cutting a frozen section of tissue in the cryostat

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The Mohs Procedure

A more intense and extremely effective basal cell skin cancer treatment is called the Mohs Procedure, named after surgeon Frederic E. Mohs in the 1930s. In this procedure, every piece of skin removed from the patient is cut as a frozen section (see above) and examined microscopically. If any cancer is seen extending to the margins, the surgeon goes back and removes more skin. This procedure is the best at removing as little healthy skin as possible while removing all of the cancerous tissue. the Mohs procedure cure rate is between 97% and 98.7%. This is different from the technique used in the routine frozen section procedure. Using that technique, only skin in which tumor can be seen with the naked eye is examined microscopically.

Frozen section procedures, especially the Mohs procedure are the most effective treatment for basal cell and squamous cell skin cancers at the present time. Because of these techniques, basal cell and squamous cell skin cancers can, in the vast majority of cases, be cured.

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    • cam8510 profile image
      Author

      Chris Mills 4 years ago from St. Louis, MO until the end of June, 2017

      Billie, that is wonderful news that they were able to remove all the cancerous tissue and cells. Let me help you emphasize, NO EATING POPCORN AFTER SURGERY JUST ABOVE THE LIP!! :) I'm glad things are looking up and that you seem to have found some peace of mind about the issue. Thanks for reading and commenting.

    • Billie Kelpin profile image

      Billie Kelpin 4 years ago from Newport Beach

      Just had the Moh's surgery for bcc (I don't like to even use the c word, but apparently the bcc is not as worrisome). ANYWAY, I'd like to mention to anyone having this surgery above the lip to try to keep your mouth as quiet as possible the first few days. Some stitches underneath broke for me and the healing takes longer when that happens. Why couldn't I just have been a little quieter and not eat popcorn (lots of lip movement in that). BUT, I'm very grateful for this surgery, wanted to kiss the Doctor afterwards, and walked out of the office with the song, "I'm the Happiest Girl in the Whole USA," ringing through my head because the bad cells were gone. Don't be scared of this surgery. PS For everyone - Don't, don't, don't forget to wear sunscreen. SPF 30 is plenty, says my doctor.

    • cam8510 profile image
      Author

      Chris Mills 4 years ago from St. Louis, MO until the end of June, 2017

      Hi Rosemay, it is the frozen section surgery which saves a lot of healthy tissue these days. It is very seldom when someone has to have large amounts of tissue taken. It is a fascinating process. Thanks for taking the time to read and comment.

    • Rosemay50 profile image

      Rosemary Sadler 4 years ago from Hawkes Bay - NewZealand

      I didn't know that testing would be done during surgery so thank you for this informative hub.

      I had a friend many years ago who lost a large part of his nose due to skin cancer

    • cam8510 profile image
      Author

      Chris Mills 4 years ago from St. Louis, MO until the end of June, 2017

      Thanks Eric, I've done this work long enough that I forget sometimes that most people aren't aware of what is going on behind the scenes during these surgeries. It is an interesting process.

    • Ericdierker profile image

      Eric Dierker 4 years ago from Spring Valley, CA. U.S.A.

      Well done friend and something we should all know about.

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