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Effective treatment by Mohs micrographic surgery requires preparation of high-quality slides.To examine a novel tissue alignment device designed to address variability in tissue processing because of excessive sample trimming.A device was designed to account for angular errors and unparalleled tissue embedding. A retrospective chart review was performed both with and without the use of the device over the course of a 4-year period (2012–2015).Between January 1, 2012, and June 10, 2014, before device implementation, mean number of stages per case was 1.65 (n = 3,680) and mean number of surgeries per day was 6.34 (n = 640). Between June 11, 2014, and October 02, 2015, with device implemented, the average number of stages per case between decreased to 1.58 (n = 2,562) and the number of daily surgeries increased to 7.05 (n = 358). This represents a significant decrease in number of stages per case by 0.07 stages (95% CI: −0.01 to −0.13, p = .02), as well as an increase in the number of cases per day by 0.71 cases (95% CI: 0.12–1.3, p < .01).Slide preparation using the novel alignment device may result in less tissue waste and more cases being performed daily.