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Published on: May 19, 2017
Using en face ink to guide the conservative sectioning of a Mohs margin
1Private practice, 525 South Dr., Suite 115, Mountain View, CA 94040, USA. jamesobarlow@gmail.com
Summary
Mohs surgery deep margins flatten easily during processing, often requiring extra sectioning to evaluate fully. En face inking helps ensure complete tissue evaluation for conservative surgical assessment.
Area of Science:
- Dermatopathology
- Surgical Pathology
- Mohs Surgery
Background:
- Mohs surgery requires tissue sectioning for margin evaluation.
- The deep margin's flattening during processing is not well understood.
- Tissue texture and contour can affect sectioning.
Purpose of the Study:
- To assess the flattening of the deep margin in Mohs specimens during tissue processing.
- To quantify the sectioning needed to evaluate the deep margin compared to the epidermal margin.
Main Methods:
- 100 routine first-stage Mohs specimens were analyzed.
- En face inking was used to delineate margins.
- Sectioning required for epidermal and deep margins was compared.
Main Results:
- 74% of specimens needed an average of 248.8 μm additional sectioning for the deep margin.
- Greater sectioning was associated with larger specimen size (p = .003).
- Less sectioning to reach the epidermal margin correlated with deep margin differences (p < .001).
Conclusions:
- Deep margins can compress and internalize irregularities during embedding.
- En face inking is valuable for delineating Mohs margin features.
- This technique ensures thorough and conservative section evaluation.
