Current histologic preparation methods for Mohs micrographic surgery.
BACKGROUND
Recently Mohs micrographic surgery, which is widely used for the removal of nonmelanoma skin cancers, has been used to remove lentigo maligna with both rush permanent sections and frozen sections. Several investigators have incorporated the use of immunohistochemical techniques to aid in the interpretation of the specimens.


OBJECTIVE
To determine the current practices of Mohs surgery laboratories, including the use of immunostains and automation of laboratory processes.


METHODS
A total of 108 laboratories responded to a written questionnaire with 13 items about the types of tumors resected, routine stains performed, average number of slides processed per day, and use of automation and immunostains.


RESULTS
Forty-nine percent of the laboratories are completely manual and 51% are automated. The Linistainer automated system, which is the predominant one used, decreased processing time by about 30% and provided an estimated 21-30% improved quality. Automation was associated with the number of slides processed. Immunostaining is performed by a limited number of laboratories which use the technique for basal and squamous cell carcinoma, lentigo maligna, and dermatofibrosarcoma protuberans.


CONCLUSIONS
Automation of routine slide preparation with a Linistainer decreased staining variability by providing a consistent environment, and decreased processing time. Most laboratories do not perform immunostaining. The relatively high cost of reagents, lack of a reliable automated process, the additional time to process specimens, and the additional technician and physician time makes the procedure impractical for many laboratories.
Robinson
J K
JK
Departments of Medicine (Dermatology) and Pathology, Loyola University Chicago, Cardinal Bernnardin Cancer Center, 2160 South First Ave., Maywood, IL 60153, USA. jrobin5@lumc.edu
D006801:Humans; D007150:Immunohistochemistry / Q000379:methods / Q000706:statistics & numerical data; D007753:Laboratories / Q000592:standards / Q000706:statistics & numerical data*; D015580:Mohs Surgery; D011786:Quality Control; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013048:Specimen Handling / Q000379:methods; D011795:Surveys and Questionnaires; D014481:United States