A better technique for taking Mohs sections involving cartilage

Background When excising Mohs layers involving skin and cartilage in the conventional manner, it can be difficult to flatten the entire margin onto a single plane because of the inelasticity of the cartilage. This is undesirable, because it prevents a complete examination of the surgical margin. Objective We describe a modified technique for excising cartilaginous specimens that allows the entire margin of the specimen to be more easily flattened onto a single plane, so that a complete examination of the surgical margin can be performed. Methods When taking Mohs layers involving skin and cartilage, we propose excising an additional 1 to 2 mm of skin and creating edges with flatter bevels of 20 degrees to 30 degrees. Results The modified technique allows the peripheral edge of the skin, the peripheral edge of the cartilage, and the deep surface of the cartilage to all be easily flattened onto the same plane, so that a complete examination of the margins can take place. Conclusion This technique allows a more thorough assessment of the margins of the excision, which will result in more successful tumor extirpation. This modified technique may be limited on cosmetically sensitive areas because it involves excising slightly more tissue than the conventional technique.