A pilot study comparing Toluidine blue and Hematoxylin and Eosin staining of basal cell and squamous cell carcinoma during Mohs surgery

BACKGROUND. Hematoxylin and Eosin (H&E) is the most common stain used for Mohs frozen sections. Toluidine blue (T-blue) is a metachromatic stain that has been frequently utilized for this purpose. OBJECTIVE. To compare the cytologic and stromal staining patterns of each stain for Mohs frozen sections of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), and to identify the advantages and disadvantages of each technique. RESULTS. T-blue revealed stromal change associated with the presence of BCC and SCC. H&E provided more prominent visibility of individual cell keratinization and necrosis, which are common features seen in SCC. CONCLUSION. We found T-blue to be fast and effective in identifying mucopolysaccharides in stroma associated with basal cell carcinoma. For this reason, T-blue is our preferred stain for BCCs, while H&E can provide greater ease of identification of histologic features of SCCs.