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From:Becky Scholes <>
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Hi, Histonetters,

   Noreen asked for some information on Mohs'.  I guess I can help - we've 
been doing them for over 20 years!  :-)
   Communicate with the dermatologist for orientation.  Ours place the 
tissue on a saline moistened 4x4 in a petri dish.  They divide into pieces 
to fit on the object holders, ink for orientation, and make a map of the 
arrangement.  A dot of ink is placed in the top left corner of the 4x4.  The 
tissue is new margin down, so flip the tissue when placing it on the OCT, 
new margin up.  Make sure the epidermis is perpendicular, so that you get a 
good cross section.  Put several step sections on the same slide, new margin 
at the top, working into the complete epidermis.
Since there usually are several resections, consider the first petri dish 
from that site as level I.  Each piece arranged on that dish are arabic 
numbers or letters, whatever you agree on.
   Staining for basal cell carcinoma usually shows up better on Toluidine 
blue.  It is also quicker.  I use a solution with urea in it for more 
intense staining.  I have the "recipe" at work.  If you are interested, I 
will post it for all.  T Blue originally was a stain coverslipped with 
water.  Since we file all frozen section slides, I experimented, and 
discovered that isopropanol did not leach the stain when dehydrating before 
coverslipping for permanent sections.  H&E stain is preferable for squamous 
cell carcinoma and lentigo melanoma.
   I hope this helps you.  If you want, I can fax our procedure to you.  I 
check my histonet every day.  Good Luck!

Bec the Tec
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