Mohs' Surgery, Fresh‐Tissue Technique: Our Technique with a Review

Abstract

A modified method of the fresh-tissue technique of Mohs' surgery is presented with a discussion of its developmental background and advantages. The refinements obviate the need for the chemical fixative. We therefore advocate acceptance of this technique in all cases of cutaneous carcinomas requiring Mohs' surgery.

Mohs micrographic surgery in the treatment of lentigo maligna and melanoma

“…Details of the fresh frozen technique used in this study have published previously [23][24][25]. MMS is a multi-step surgical procedure involving excising tissue layer by layer and microscopically examining the entire undersurface through specific tissue harvesting, mounting, and cutting techniques [26].…”

Postfixation of Cryostat Sections Improves Tumor Definition in Mohs Surgery

“…When Mohs 9 used the fresh frozen technique, he omitted formaldehyde fixation and instead used 95% ethyl alcohol for 15 seconds for dehydration of the cryostat sections. Cottel et al 11 fixed specimens in “absolute alcohol instead of formalin to decrease the risk of (the tissue) floating off the slide” after cryostat sectioning, while Picoto and Picoto 10 used a frozen section fixative after cryostat sections were obtained.…”

“…PF is the process whereby tissue fixation is achieved by immersion in a fixative for a brief period, immediately after cutting 5–6‐μm cryostat sections (Table 1). In a review of the literature, various fixation techniques have been proposed, but few have adopted PF as a part of their standard processing of Mohs sections 5,9–11 …”

Artifacts in Frozen Section Preparation

“…It is important to keep the tissue flat on the cryostat blade and to maintain this as it is transferred to the warm glass slide. 7,8 During the staining process folding may occur as the slides are dipped in and out of the staining baths. Moisture on the slide or beneath the tissue can also cause folding.…”