Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
Harvard Combined Dermatology Residency Training Program, Boston, MA, USA.
Int J Dermatol. 2019 Oct;58(10):1210-1211. doi: 10.1111/ijd.14591. Epub 2019 Jul 17.
Traditionally, Mohs layers are excised using a beveled incision to facilitate tissue flattening for tangential sectioning. Some surgeons perform non-beveled incisions; however, these specimens may be harder for the histotechnician to process. Limited data exist comparing slide quality between these techniques.
Retrospective review of cases performed by two Mohs surgeons (surgeon 1 = non-beveled incision; surgeon 2 = beveled incision) using different incision angles between June 2014 and December 2016. Daily histopathologic slide quality assessment scores (maximum score = 5, minimum score = 1) of the day's first case were compared.
About 536 slides (surgeon 1 = 277, surgeon 2 = 259) were evaluated from 2,825 cases. Mean quality assessment scores were similar between surgeons (4.89 and 4.86; P = 0.31) with missing or folded epidermis being the most commonly reported issue for both surgeons.
Similar slide quality can be achieved via both beveled and non-beveled Mohs cutting angles. While more relaxing incisions may be necessary to optimize tissue flattening with non-beveled incisions, there is no associated increased loss of epidermal margins. The potential benefits of non-beveled incisions, such as minimizing tangentially cut adnexal structures and creating vertical wound edges optimized for repair, may offer an alternative technique with positive clinical implications.
传统上，Mohs 层是通过斜切口切除的，以利于组织扁平化进行切线切片。一些外科医生不做斜切口；然而，这些标本可能更难让组织技术员处理。关于这些技术之间的切片质量比较，数据有限。
对 2014 年 6 月至 2016 年 12 月期间由两位 Mohs 外科医生（外科医生 1=非斜切口；外科医生 2=斜切口）进行的病例进行回顾性研究。比较了每天第一例病例的每日组织病理切片质量评估评分（最高得分为 5，最低得分为 1）。
从 2825 例病例中评估了约 536 张切片（外科医生 1=277 张，外科医生 2=259 张）。两位外科医生的平均质量评估评分相似（4.89 和 4.86；P=0.31），两位外科医生最常报告的问题是表皮缺失或折叠。
通过斜切和非斜切的 Mohs 切割角度可以获得相似的切片质量。虽然非斜切切口可能需要更放松的切口来优化组织扁平化，但不会导致表皮边缘的损失增加。非斜切切口的潜在好处，如最小化切线切割附属结构和创建垂直的伤口边缘以优化修复，可能提供一种具有积极临床意义的替代技术。
