Mohs surgery and processing: Novel optimizations and enhancements

OBJECTIVE. Simple yet effective modifications to Mohs surgery and processin g may enhance procedural efficiency, ensure proper tissue orientation and t racking, while greatly reducing "recuts." Using the methods described, Mohs specimens no longer need to be incised or excised with any bevel, thus con serving tissue and facilitating closure. METHODS. A streamlined Mohs surgical tray is convertible to a closure tray within seconds. The excised tissue specimen is oriented on a sterile paper square on a reusable sterilized aluminum palette where partial thickness ci rcumferential and radial scalpel cross-hatching allows epidermal edges comp lete freedom to later adhere to a flattening glass. The sterile paper can b e labeled with patient name, stage number, and chuck number; then the speci men is inked. Rapid chuck freezing in a specially positioned liquid nitroge n immersion is followed by OCT (embedding compound) application. Uniquely n umbered and modified cryostat chucks eliminate the possibility of OCT-chuck disunion. Rapid liquid nitrogen immersion of a glass surface allows the in ked, cross-hatched specimen's epidermal edges and base to lay perfectly fla t once forced against the supercooled glass surface using a special polymer glove. Inversion of the specimen-containing glass onto a frozen and gel st ate OCT interface of the chuck completes the embedding. RESULTS/CONCLUSION. These reproducible approaches to Mohs surgery described herein utilize multiple modifications that enhance the speed, efficiency, and reproducibility of Mobs specimen embedding, specimen preparation, while maintaining accuracy of interpretation.