Large Elliptical Specimens and the Single Section Method

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Mohs micrographic surgery (MMS) may be a time-consuming procedure, particularly when treating large tumors. Large tumors frequently require the Mohs histotechnician to divide the excisional specimen into multiple pieces before being separately mounted in frozen section medium, horizontally sectioned, mounted on glass slides, stained, and coverslipped for microscopic examination. After obtaining clear margins, the surgeon must convert a large oval or circular defect into an ellipse, undermine the wound, obtain hemostasis, and perform a layered closure. In this article, the authors will review the benefits of harvesting large elliptical specimens in the first stage of MMS and processing these specimens by the single section method, in which the entire specimen is mounted on one glass slide. The single section method obviates the subdivision and separates processing of excisional specimens. By harvesting an elliptical specimen instead of an oval specimen, the surgeon is able to quickly repair the elliptical defect after clear margins are obtained. This article provides Mohs surgeons with a method of increasing the efficiency and speed of processing frozen sections without compromising patient care.
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