MOHS obviously does NOT have to be done this way, with poor equipment.  The
amount of money they make performing this procedure (having paid for a
MOH'd nose) should more than pay for decent knives, microscopes and
training in the expertise of doing MOHS.  

Maybe the money earned goes solely to the liability insurance to pay for
any mistakes that can turn up later, since it doesn't seem to go towards
any equipment/working condition upgrades.  I feel confident I will have my
nose for the next 40 years, and the next bout with any reconstructive
surgery will be to uplift a face and sagging derriere! 
 
To some it may be the @#^*%# four letter word left unsaid, but maybe the
words that are truly unsaid are "Continuing Education in MOHS Technic".
Check into NSH convention/symposium this year, several MOHS related topics
for a growing area of histopathology, you might want to enlighten the
attending physician about this, he may just spend some of those dollars on
a workshop.  It would be in the best interest of his patients. 

Must be Monday, left off from Friday ------   




At 01:44 PM 8/4/00 -0400, you wrote:
>OK, four people have asked for it, so I guess I'll try to describe my week
in 
>Mohs hell. By my long gray beard and glittering eye, now wherefore stopp'st 
>thou me?
>
>A small private pathology practice in a high risk area of the country for 
>skin cancer. The solo pathologist (none of the other pathologists in town 
>will touch it) drives a short distance to the dermatologist's clinic. 
>Appointments with the pathologist are made in advance, usually in the early 
>afternoon. I filled in for him while he was on vacation.
>
>The dermatologist is young, personable, and honest. He actually does 
>something you could call Mohs surgery. He cuts out the tumor in a 
>saucer-shaped piece, roughly circular as a rule. He may have two patients 
>going at once. He operates looking through a 2-power loupe (rather than an 
>operating microscope such as an otolaryngologist or ophthalmologist) and the 
>pathologist has a lighted magnifier also.
>
>The frozen section attempts to display the entire raw surface of the tumor, 
>and the epidermal margins, all in one piece. To do this, the specimen is 
>squashed flat against a plastic plate, and frozen using nothing more 
>sophisticated than compressed gas (what once was Freon). I won't try to 
>describe the inking.
>
>The cryostat is an ancient Ames Tissue-Tek, but it works. Blades are 
>non-disposable and dull. The stain is H & E, done without Coplin jars, just 
>pour it on the hand-held slide and wash it off, finally mounting in an 
>aqueous medium. The room had no running water.
>
>Results? Catastrophic. Usually I couldn't even see the section because of
the 
>low refractive index of the mounting medium. I had no idea whether the 
>sections were flat or not. Sometimes the dermatologist looked at the
sections 
>- he thought they were fine, and I wasn't going to tell him otherwise.
>
>Frankly, I had to falsify results to escape with a whole hide. Am I going 
>back there? No way. Perhaps this procedure can be done honestly, but not by 
>me in the conditions I worked in. 
>
>As I've said before, it's the dirtiest four letter word in surgical
pathology.
>
>Bob Richmond
>Samurai Pathologist
>Knoxville TN
>
>
>
Gayle Callis
Veterinary Molecular Biology
Montana State University
Bozeman MT 59717-3610
406 994-4705
406 994-4303