Practice Preferences of Mohs Histology Technicians: A Web-Based Survey

BACKGROUND: Frozen section processing (FSP) enables real-time histologic margin assessment during Mohs micrographic surgery (MMS). FSP techniques are variable, and processing speeds are poorly characterized. OBJECTIVE: To identify rate-limiting steps and technique variations in FSP. MATERIALS AND METHODS: A web-based survey was distributed to MMS and dermatopathology technicians assessing slow steps, challenging tissue types, technique variability, prevalence techniques, and practice preferences. RESULTS: A 5-point Likert rating of 3 to 5 was defined as slow. Response rates above 50% categorized the step as slow, and response rates below 50% categorized the step as fast. Slow steps included flattening/debulking (78%), sectioning (58%), staining (58%), and embedding (53%). Fast steps included aligning the cryotome (40%), acquiring the sample (22%), mounting to a chuck (18%), mounting to a slide (16%), inking (9%), and adding a coverslip (8%). Difficult-to-section tissues were adipose (65%), cartilage (46%), and thin tissue (39%). Variable steps include flattening/debulking (36%) and embedding (36%). The most common preparation method was the glass slide technique (63%), then the heat extractor (28%), and finally well bars (9%). Most did not use an embedding device (59%). CONCLUSION: Flattening/debulking, embedding, sectioning, and staining can benefit from increased processing speed. Simplifying adipose, cartilage, and thin tissue processing can reduce the burden on technicians.