Dermatopathology

In dermatopathology, frozen sections are used when immediate histologic assessment improves patient care. Frozen sections guide the course of surgery, providing margin control and diagnostic information. Pathologists and Mohs surgeons perform the majority of cutaneous frozen sections. In Mohs surgery, a surgeon trained in the resection, histologic diagnosis, and reconstruction of cutaneous malignancies acts as both the surgeon and pathologist. Mohs surgery provides treatment advantages, achieving higher cure rates with greater tissue conservation than standard excisions. Additional uses for frozen sections specific to the skin are in the rapid diagnosis of potentially-fatal fungal infections and the severe hypersensitivity reactions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Technical differences in tissue processing create artifacts and distortions that may create diagnostic challenges when compared to formalin-fixed, permanent sections. In this chapter, we will discuss the technical preparation and diagnostic pitfalls of frozen sections in dermatopathology.