- Email: [email protected]
Surgical Pearl: colored tissue–mounting medium for Mohs surgery
PEARLS
Surgical Pearl: Colored tissue–mounting medium for Mohs surgery Raymond T. Kuwahara, MD, Rachel McElroy, Carlos A. Garcia, MD, and Raymond L. Cornelison, MD Oklahoma City, Oklahoma
T
he Mohs micrographic surgery technique requires careful marking and diagramming of each tissue layer so that only tissue with tumor present is removed.1-3 Keeping track of tissue sections of multiple Mohs’ surgery cases can be difficult and challenging for the surgeon and histotechnologist. The major concern is that tissue specimens from one patient are not mistaken for those of another patient. The potential for faulty information can lead to inappropriate or inaccurate management. With multiple tissue sections in the cyrostat, the histotechnologist and the Mohs surgeon require a quick method to recognize the different patients’ tissues. Presently, methods to keep track of several patients’ tissues include marking the bit, marking on the frozen section, and taking pictures. However, sometimes these marks may become illegible or smeared. As a solution, we have found that using different colored tissue–mounting media for each patient is a simple and quick way to segregate tissue sections. Each patient then has his or her own colored gel. Using colored tissue–mounting medium in conjunction with marking the frozen section will further decrease the chance of mistaking frozen sections between patients.
TECHNIQUE The colored tissue–mounting media can either be purchased commercially or prepared from readily available clear gel and food coloring. Five colors are commercially available: blue, green, red, yellow, and clear. If more than 5 patients (or tumors) are scheduled, the surgeon may complete the fifth surgery and then recycle colors for the sixth, seventh, From the Department of Dermatology, University of Oklahoma. Funding sources: None. Conflict of interest: None identified. Correspondence to: Raymond T. Kuwahara, MD, 619 NE 13th St, Oklahoma City, OK 73104. E-mail: [email protected]. J Am Acad Dermatol 2003;49:706-7 Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 ⫹ 0 doi:10.1067/S0190-9622(03)00759-X
706
Fig 1. Colored tissue–mounting medium is used in place of clear tissue–mounting medium. This enables easy identification by the histotechnologist.
Fig 2. Colored tissue–mounting medium can be made inexpensively by adding 1 drop of food color to clear tissue–mounting medium. A box of food coloring costs about $2.
and eighth cases, and so on. Using a marking pen to identify the patient on the tissue mounting medium can further decrease chance of mistaken identity. The colored medium can be used in 2 ways. In the first, colored tissue–mounting medium can be placed initially on the chuck as the identifying code. Then, clear tissue–mounting medium can be placed on top with the tissue embedded within the upper layer. The other method is to simply use the colored tissue–mounting medium as the embedding gel (Fig 1). The minute amount of coloring does not affect the staining solutions.
J AM ACAD DERMATOL VOLUME 49, NUMBER 4
Each bottle of colored tissue–mounting medium lasts approximately 1 month and costs about $2 more than the clear gel. An inexpensive method of creating one’s own colored gel is to add 1 drop of food coloring to each bottle of gel (Fig 2). Food coloring can be purchased at the local supermarket for approximately $2, enough to last a typical Mohs’ surgeon for several years. One drop is placed into the gel and simple diffusion spreads the dye into the gel. By inverting the bottle, diffusion is further facilitated. Letting the gel sit for a day creates a translucent-colored tissue–mounting medium, similar to the premanufactured medium at less cost. Using colored cryostat gel for different patients
Pearls 707
can significantly decrease the chance of mistaking tissue specimens between patients. Colored tissue– mounting medium is easily and quickly recognized by the histotechnologist, which reduces error associated with multiple tissue processing.1-3
REFERENCES 1. Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg 1941;42:279-95. 2. Tromovitch TA, Stegman SJ. Microscopically controlled excision of skin tumors: chemosurgery (Mohs): fresh tissue technique. Arch Dermatol 1974;110:231-2. 3. Gross KG, Steinman HK, Rapini RP. Mohs surgery: fundamentals and technique. St Louis: Mosby Yearbook; 1998.
Surgical Pearl: Colored tissue–mounting medium for Mohs surgery Raymond T. Kuwahara, MD, Rachel McElroy, Carlos A. Garcia, MD, and Raymond L. Cornelison, MD Oklahoma City, Oklahoma
T
he Mohs micrographic surgery technique requires careful marking and diagramming of each tissue layer so that only tissue with tumor present is removed.1-3 Keeping track of tissue sections of multiple Mohs’ surgery cases can be difficult and challenging for the surgeon and histotechnologist. The major concern is that tissue specimens from one patient are not mistaken for those of another patient. The potential for faulty information can lead to inappropriate or inaccurate management. With multiple tissue sections in the cyrostat, the histotechnologist and the Mohs surgeon require a quick method to recognize the different patients’ tissues. Presently, methods to keep track of several patients’ tissues include marking the bit, marking on the frozen section, and taking pictures. However, sometimes these marks may become illegible or smeared. As a solution, we have found that using different colored tissue–mounting media for each patient is a simple and quick way to segregate tissue sections. Each patient then has his or her own colored gel. Using colored tissue–mounting medium in conjunction with marking the frozen section will further decrease the chance of mistaking frozen sections between patients.
TECHNIQUE The colored tissue–mounting media can either be purchased commercially or prepared from readily available clear gel and food coloring. Five colors are commercially available: blue, green, red, yellow, and clear. If more than 5 patients (or tumors) are scheduled, the surgeon may complete the fifth surgery and then recycle colors for the sixth, seventh, From the Department of Dermatology, University of Oklahoma. Funding sources: None. Conflict of interest: None identified. Correspondence to: Raymond T. Kuwahara, MD, 619 NE 13th St, Oklahoma City, OK 73104. E-mail: [email protected]. J Am Acad Dermatol 2003;49:706-7 Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 ⫹ 0 doi:10.1067/S0190-9622(03)00759-X
706
Fig 1. Colored tissue–mounting medium is used in place of clear tissue–mounting medium. This enables easy identification by the histotechnologist.
Fig 2. Colored tissue–mounting medium can be made inexpensively by adding 1 drop of food color to clear tissue–mounting medium. A box of food coloring costs about $2.
and eighth cases, and so on. Using a marking pen to identify the patient on the tissue mounting medium can further decrease chance of mistaken identity. The colored medium can be used in 2 ways. In the first, colored tissue–mounting medium can be placed initially on the chuck as the identifying code. Then, clear tissue–mounting medium can be placed on top with the tissue embedded within the upper layer. The other method is to simply use the colored tissue–mounting medium as the embedding gel (Fig 1). The minute amount of coloring does not affect the staining solutions.
J AM ACAD DERMATOL VOLUME 49, NUMBER 4
Each bottle of colored tissue–mounting medium lasts approximately 1 month and costs about $2 more than the clear gel. An inexpensive method of creating one’s own colored gel is to add 1 drop of food coloring to each bottle of gel (Fig 2). Food coloring can be purchased at the local supermarket for approximately $2, enough to last a typical Mohs’ surgeon for several years. One drop is placed into the gel and simple diffusion spreads the dye into the gel. By inverting the bottle, diffusion is further facilitated. Letting the gel sit for a day creates a translucent-colored tissue–mounting medium, similar to the premanufactured medium at less cost. Using colored cryostat gel for different patients
Pearls 707
can significantly decrease the chance of mistaking tissue specimens between patients. Colored tissue– mounting medium is easily and quickly recognized by the histotechnologist, which reduces error associated with multiple tissue processing.1-3
REFERENCES 1. Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg 1941;42:279-95. 2. Tromovitch TA, Stegman SJ. Microscopically controlled excision of skin tumors: chemosurgery (Mohs): fresh tissue technique. Arch Dermatol 1974;110:231-2. 3. Gross KG, Steinman HK, Rapini RP. Mohs surgery: fundamentals and technique. St Louis: Mosby Yearbook; 1998.