JAAD ONLINE: SURGICAL PEARL

Basic mold to improve tissue processing

efficiency and consistency in
Mohs surgery
Ryan Ladd, MD, Debra Keith, HT (ASCP), and Shari Ochoa, MD

Key words: efficiency; histopathology; Mohs Surgery; mold; tissue processing.

Abbreviation used:
OCT: optimal cutting temperature

H igh fidelity tissue processing is paramount to accurate pathology assessment, and therefore, cure rate in
Mohs Surgery. Classically, tissue processing begins with specimen placement on the stage blade holder
of the cryostat and optimal cutting temperature (OCT) application. Once frozen, the OCT and specimen
are inverted and placed onto a chuck for freezing with additional OCT. Disadvantages of this method include
wasted movements that reduce efficiency, inconsistent shaping of OCT requiring manual contouring with sharp
instruments, and lack of controlled OCT application resulting in wasted OCT and larger OCT margins.

SOLUTION
We present a method to embed tissue in one step that reduces the amount of OCT required, eliminates the
need for OCT shaping after embedding (avoiding exposure to sharps), and allows easier placement of more cuts
on a slide. The process begins by placing 2 L-shaped aluminum rods (patent pending) together to form a
rectangle around the specimen. OCT is applied within the mold, which is the size of a glass slide at its maximum
(Fig 1). A heat sink is placed on top, freezing the mold from both sides. We use variably sized heat sinks to freeze
up to 10 specimens simultaneously, which mitigates a potential drawback of the extra space utilized by the rods.
The mold is removed (Fig 2) and placed on the chuck for cutting. Only a small rim of OCT remains, allowing for
more cuts of the specimen to be easily placed on a slide to facilitate more efficient review by the Mohs surgeon.

From the Department of Dermatology, Mayo Clinic Arizona,
Scottsdale, Arizona.
Funding sources: None.
IRB approval status: Not applicable.
Reprints not available from the authors.
Correspondence to: Ryan Ladd, MD, Department of Dermatology,
Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259.
E-mail: Ladd.ryan@mayo.edu.
J Am Acad Dermatol 2023;jj:ej-j.
0190-9622/$36.00
Ó 2023 by the American Academy of Dermatology, Inc.
https://doi.org/10.1016/j.jaad.2023.03.017

e1
e2 Ladd, Keith, and Ochoa J AM ACAD DERMATOL
n 2023

Fig 1. Small L-shaped aluminum rods (30 3 60 mm) placed around the specimen (cooked
chicken for demonstration purposes) with optimal cutting temperature applied, just prior to
heat sink application over the top.

Fig 2. Rectangular mold with small rim of optimal cutting temperature around the embedded
specimen prior to cutting.

Conflicts of interest
None disclosed.