Preparing Mohs Frozen Sections Using the CryoHist™

Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review

“…Timesaving was defined as time reductions in tissue orientation/slide preparation, 12,[15][16][17] Mohs mapping, 18 embedding, 19 freezing, 8 specimen mounting, 9 tissue sectioning, 13 slide interpretation, [20][21][22][23] wound closure, 24,25 increased number of cases per day, 24,26 less time needed to train technicians on devices, 15 or a combination of these. 5,14,[27][28][29][30][31][32][33][34][35][36]…”

“…5,13,22,24,27,34,47,59 In 12 studies, new devices were evaluated with a primary outcome of faster processing time. Devices evaluated included the cryomold, 45 CryoCaddy, 31 CryoHist, 9,17 CryoCup, 19 Miami Special, 19,46 a novel tissue alignment device, 26 a precision machine for mounting, 49 PrestoChill, 16,33 and Presto stainer. 16 Of those studying devices, investigators of 10 studies evaluated devices that were either loaned by the manufacturer or created by the authors themselves.…”

“…16 Of those studying devices, investigators of 10 studies evaluated devices that were either loaned by the manufacturer or created by the authors themselves. 15,17,19,20,26,31,33,46,50,65…”

“…In 20 studies, investigators made efforts to decrease histologic artifacts (33%), with those from 7 studies defining it as decreased freezing artifact for embedding medium, 5,[31][32][33]40,41,59 from 4 studies defining decreased artifact as decreased crush artifact during mounting, 14,31,49,67 from 1 study defining it as decreased venetian blind-type artifacts, 68 from 7 studies defining decreased artifact as decreased folds and air bubbles during tissue flattening, 12,54,55,58,[68][69][70] from 3 studies defining it as decreased holes in subcutaneous tissue, 17,20,68 and from others defining it as decreased floaters when staining or marking borders of tumor margin and avoidance of contamination during sectioning. 14,22,29,30,38 One study group assessed the overall appearance of slides using 3 criteria: the ability to visualize normal melanocytes, the ability to visualize atypical melanocytes, and the overall ability to see epidermal and dermal structures.…”

“…65 In 14 studies, technique alterations were referred to such as use of face paraffin-embedded sections, 55,70 flash freezing, 32 horizontal relaxing incisions for Mohs sections, 38 alterations in mapping, 22,70 the use of needles as opposed to forceps for tissue stabilization, 67 and debulking friable tissue. 29 Six articles included the evaluation of new devices to decrease artifact during processing, including the Presto-Chill device to reduce need for tissue trimming and better preserve tissue structures, 33,41 a tissue press prototype for tissue flattening, 69 the CryoHist, 17 the cryomold, 14 and the CryoCaddy. 31 Two of the studies evaluated were sponsored by device manufacturers (PrestoChill and CryoCaddy).…”