Large Elliptical Specimens and the Single Section Method

Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review

“…In 35 studies, timesaving was evaluated (57%). 5,8,9,11–13,15–36,45–47,50,59,65,66 Timesaving among 6 studies reported “time saved” relative to individual steps in the MMS processing (mounting, embedding, freezing, slide preparation, slide fixation, staining, and clearing) ( n = 6). 19,20,32,40,45,49 Timesaving outcomes also included processing time of the first complete section ( n = 3) 13,27 and number of cases completed per day ( n = 1).…”

“…However, most studies included anecdotally claimed timesaving without any clear measurements of time. 5,9,[11][12][13][15][16][17][18][21][22][23][24][25][26][28][29][30][31][33][34][35][36]45,47,50,59,65,66 Overall, similar to studies examining artifact reduction, timesaving studies often did account for reproducibility of their findings given the variable practices across MMS laboratories. Furthermore, recurrence rates were not assessed in studies despite the potential-negative impacts of timesaving methods on MMS processing quality.…”

“…Timesaving was assessed in 35 studies through technique alterations and alternative devices. 5,8,9,11–13,15–36,45–47,50,59,65,66 The most commonly discussed direct measures of timesaving were related to individual steps in MMS processing. 19,20,32,40,45,49 Indirect measures included number of cases completed per day and required technician training times.…”

“…8,19,20,27,32,46 Most studies reported no unit of time, but alternatively inferred timesaving practices such as the elimination of certain MMS processing steps, 11,21,30,47,58 increase in number of cases per day, 26 or decreased number of technician training hours. 15 Of the 35 assessed, 23 studies included referenced alterations in technique including alterations to tissue mapping technique, combining processing steps, 8,30 flattening specimens with molds and glass discs, 20 use of optimal cutting temperature (OCT) droplet compound, 11,12 flash freezing, 32 microwave processing of paraffin sections, 36,65 modifying single-section methods for processing specimens, 18,21,23,28,66 use of alternative gloves and alternative incisions for processing, 25,29 techniques to quickly separate subcutaneous fat from specimen processing, 35 and other preparation changes. 5,13,22,24,27,34,47,59 In 12 studies, new devices were evaluated with a primary outcome of faster processing time.…”

Elliptical Mohs layer to reduce number of Mohs stages and increase clinical efficiency

“…Nonetheless, the tissue can still be processed in a single section or bisected without compromising slide quality. 2,3 If the margin is positive, further tissue can be removed along the positive margins while preserving the elliptical shape of the defect. 4 This technique is different from narrow margin standard excision in that tangential frozen sections are prepared with complete margin evaluation in real-time.…”