Dear 16-year-old Me

Do you wish you could go back and tell your 16 year old self to do things differently? Things like wearing sunscreen instead of oil at the beach, forgetting those tanning beds you just had to use before a special occasion, or even though you were sunburned, you still sunbathed the next day?

It might not be too late to start protecting your skin. Share this video with younger children so they can be educated on what can happen in the future.

Eye Wedge Model

One of our very talented mohs technicians, Michelle, made an amazing creation of an eye wedge. Sometimes when eye wedges are placed in front of us, it can be confusing to know just exactly how dissect and ink. This model lets you really see what part of the skin it came from and how to properly lay it down for perfect sections every time. Thanks Michelle!

Ask a Mohs Tech- Tattoo sections

Ever wonder what skin looks like under the microscope with tattoo ink? One of our mohs technicians captured a great picture to share. Also a great picture of complete epidermis and good stain.

WE KNOW MOHS

Ask a Mohs Tech- Rubber band Trick

Rubber Band- Double Duty

Daily use of cryostats can put a lot of wear and tear on the screws inside, especially the screws that hold the knife plate in place. You should always update your screws, as they can get stripped easily, but incase you don't have time here's a great tip found in the Good House Keeping Magazine. They probably weren't talking about cryostats, but in this case it's perfect for Mohs!

To get a better grip on a stripped screw, trap one side of a wide rubber band (like the ones used on a produce bundle) between the screwdriver and the screwhead, and twist!

Staining Thick Cuts

Cutting thicker sections where the stain comes out perfect every time.

Thicker pieces need extra time to dehydrate. This means more time in the first alcohol is a must. Normal time in the first alcohol is 30-60 seconds, increase this time to 90-120 seconds to draw all the water out of the dense tissue.

Add time to your hematoxylin. Doubling the time should help the stain penetrate the thick tissue. Be sure to use extra washing dips in the waters following the hematoxylin. It is important to perform these extra dips to insure the hematoxylin is properly blued.

Your Eosin will also need to be increased, add about 50% of what is used normally. For example, if you were using one dip, use one plus a quick second dip. If two dips was your norm add one extra dip for a thick cut.

The last set of alcohols need extra dips as well, about double what you use for tissue of normal thickness.

Your slides should look much better under the microscope after following these steps.

WE KNOW MOHS

Hematoxylin, where does it come from?

Hematoxylin- We always manage to take a little home with us whether it's on our hands, scrubs or shoes. Our work spaces need special attention after using it because it's stain power is so great. So where does our dirtiest, yet important, step in work come from?

The stain Hematoxylin is a natural dye derived from the Haematoxylum campechianum or logwood tree. This tree is found throughout Guatemala, Belize, and the Yucatan Peninsula of Mexico. The bark and sapwood of the tree are extremely hard and protect the very hard, very heavy, deep red-colored heartwood of the tree. Haematoylum derives its name from the Greek word "haemato" for blood and "xylo" for wood. Interestingly enough, hematoxylin is extracted from chips of the heartwood using hot water or steam and has been used to treat diarrhea and dysentery and the seeds are used locally as a flavoring for food. It is then oxidized to form a compound with strongly colored metal ions in it.

The Spanish discovered Hematoxylin in 1502 and began trading it with Europeans who used it for dying fabrics. English political economist Sir William Petty estimated that the average value of merchandise a ship of the 1600's could carry in a year was 1000-1500 pounds of sterling. A single load of 50 tons of logwood was worth more than an entire year's cargo of other merchandise! Because of the wood's great value the British logwood ships were a constant target for pirates. There were also frequent conflicts with the Spanish over the right of the British to settle in Belize and cut logwood. During the eighteenth century Spanish troops attacked the logwood camps many times. During the 1700's and 1800's, France encouraged its chemists to explore the dyeing properties of this logwood. In 1810, a French chemist named Michel Eugene Chevreul isolated hematoxylin crystals. The combination of hematoxylin with eosin was first proposed in 1871, forming one of the most used combinations in histology today. The compound is used to stain the nuclei of all the cells prior to examination under a microscope. Interestingly, in the 1970's due to the over cutting of forests in Brazil and Central America, there was a shortage of logwood and therefore of hematoxylin.

Be sure to use your stain wisely!

The deeply fluted, corrugated trunk of logwood is unmistakable
in the dense jungle of northern Belize

A freshly-cut piece of heartwood from a logwood tree along the New River turns the water in this container a blood red. The hematoxylin dye dissolves readily in fresh water

The scenic New River of the northern Belize, where Baymen (logwood cutters) once harvested logwood. The trees still grow in the dense tropical forest and jungle along the river

Leaves and branches of the logwood tree


To this day, a black and white logwood cutter are depicted in the national emblem of Belize, which appears on the currency and the Belize flag.

Cutting Cartilage

The hardest part about cartilage specimens is getting it to lay down and stay on the slide. But once it's mounted, you'll find that it cuts relatively smooth. Now that + (plus) slides are available, the cartiliage will not fall off as easily. However, there are a couple of tips you can do to make sure you deliver the best slides possible.

After taking the desired amount of sections, keep the slides on the hot plate a little longer than usual. If timed right, usually around 30-60 seconds. Be careful not to heat it too long, as sections can become burnt. After the hot plate, place the slides in the alcohol cup and let sit for 30 seconds, instead of dipping continously. Then slowly dip through the rest of the cups. The slower you dip or let sit, the less likely cartilage will fall off.

With these tips, you'll be sure to make great mohs slides

W E K N O W M O H S

FREE SKIN CHECKS

Protect your skin with sunscreen- Check!

Stay away from long periods of sun exposure- Check!

Book a yearly skin check screening- ???

Many people are great about taking care of their skin, but not so great when it comes to seeing a Doctor for annual checkups. No one likes to see a Doctor incase something might be wrong, but we can't think this way. In fact, if seen in it's early stages, skin cancer can be treated and most of the time, with minimal skin removed.

-Here's an even better reason to get checked now-

Free Skin Screenings are now being offered!

Complimentary skin screenings are available through programs from the American Academy of Dermatology and the Amercian Society for Dermatologic Surgery in partnership with Neutrogena. The Skin Cancer Foundation is also providing free skin exams- and sunscreen samples- in a traveling RV tour bus(38 foot with 2 exam rooms) in this year's Road to Healthy Skin Tour, sponsored by Aveeno and Rite Aid.

Check out these websites for more information

www.skincancer.org/tour

http://www.melonomamonday.org/

Here are a few Southern California Dates- Rite Aid address to be determined...

8/14/11 - Pasadena

8/17/11 -Anaheim

8/18/11 -Huntington Beach

8/20/11 -San Diego

8/21/11 - San Diego

Look out for the Healthy Skin RV tour bus near you!

Melanoma Month

May is Melanoma/Skin Cancer Detection

and Prevention Month

The incidences of most cancers in the United States are decreasing, but the number of skin cancers are increasing. You can reduce your risk of getting skin cancer by following these refresher prevention tips provided by skincancer.net.

Sun Protection Practices

1. Avoid deliberate tanning. Lying in the sun may feel good, but the end result is premature aging( wrinkles, blotchiness, and sagging skin) as well as 1 in 5 chance of developing skin cancer. Tanning beds and sunlamps are just as dangerous because they emit enough UV radiation to cause premature aging and skin cancer. Use a sunless self-tanning product instead, but remember to still use sunscreen on top.

2. Get vitamin D safely through a healthy diet that includes vitamin supplements.

3. Generally apply sunscreen to all exposed skin every day. The sunscreen should have a SPF of at least 30 and be broad-spectrum(provides UVA/UVB protection). Suncreen does NOT make sun bathing safe.

Tip- Don't forget your ears, nose, neck, hands, and toes. Many skin cancers develop in these areas. Protect your lips, another high risk area, with lip balm that offers SPF 30 or higher

4. Seek shade when appropriate. Sun's rays are stronger between 10am-4pm

5. Use extra caution near water, snow, and sand as they reflect damaging rays of the sun.

6. Check your birthday suit on your birthday. (or maybe the day after...) If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early. Don't forget to ask if their Mohs Tech is from Mobile Mohs! :)

-More Good Reasons to Practice Sun Protection-

Aside from skin cancer, sun's UV rays also cause...

- Premature aging
- Immunosuppression( weakening of the body's ability to protect itself from cancer and other diseases)
-Cataracts and macular degeneration- Macular degeneration, for which there is no cure, is the leading cause of blindess in people aged 65 and older.

This information isn't meant to scare you away from spending time outside in the sun. A little bit of sun can be a great mood booster, just make sure you're covered and apply your sunscreen every so often, and you'll be good to go!

Healthy Tips

As a Moh Tech, our day to day job can vary with how many hours we'll work. Sometimes we are so busy that we don't realize we haven't had anything to drink or eat since breakfast. Staying hydrated and fueling your body is very important when it comes to maintaining your energy levels. Here are some tips for keeping your energy up.

Hydrating your body

According to mayoclinic.com "Water is your body's principle componet and makes up to 60% of your body weight. Every system in your body depends on water. Lack of water can lead to dehydration and even mild dehydration can drain your energy and make you tired. Drink eight 8oz glasses of water each day."

Sounds simple right? But how many of us can really say we drink 64 ounces of water everyday?

Solution- Bring a water bottle everywhere you go. Most offices have water coolers available, but are usually in the staff kitchen or waiting room. Having your own water bottle nearby makes it more accessible. Try to drink at least 2 full bottles while at work. I like to multi-task by drinking water while I stain my slides. One hand is staining, while the other is hydrating. Try it!

Fueling your body

Do you start to get hungry around 10am? Feel drained and tired around 2 or 3pm? Don't go for that second or third cup of coffee, instead reach for a snack. According to Fitnessmagazine.com, "snacking keeps your metabolism revved up and is a great way to boost your energy. You need a snack that's full of nutrients to power you through your between-meal stretch."

Fitness Magazine recommended energy boosting snacks

1- Fresh Bananas, Apples, Oranges & Berries- Loaded with vitamin C, antioxidants, and fiber, as well as good carbs for an energy boost. Serving size- 1 piece fresh fruit or 1 cup chopped or berries

2-Yogurt & Cereal - Sprinkle some crunchy cereal on yogurt for a great snack. You'll get carbs and protein from the Yogurt and energy from the cereal, making you fuller longer. Serving size- 1- 6oz cup

3- Popcorn- is actually a healthier snack than pretzels and provides fiber. Microwave beforehand and bring in a ziplock bag, or bring a small serving size bag to pop at work.

4- Half a turkey sandwich- You can have real food as a snack too. 1 slice whole wheat bread, 2 ounces of turkey, and mustard provides energy boosting carbs and protein.

5- Red Pepper & Hummus - Vegetables offer good fiber, plus loads of nutrients and vitamins, while hummus adds some protein to up the snacks staying power. Serving size- unlimited vegetables with 1/4 cup hummus.

6- Almonds & Walnuts- packed with good fats, fiber, vitamin E and omega 3's. To stop yourself from overeating, fill an altoid tin with nuts for the perfect serving size(about an ounce)

7- Soy Crisps- sometimes you just want a snack food type of snack. These are salty and crunchy with 5 grams of protein per serving and have more staying power than chips or pretzels. Serving size- Eat the whole 2 serving bag!

Would you make the Cut?

What does it take to be a Mohs Technician at Mobile Mohs, Inc. ?

Our technicians process some of the best slides in the country. Here is how we select our Mohs Technicians...

Our selection process starts with an extensive interview process by Mobile Mohs, Inc. and culminates with the approval of completion of training by Mobile Mohs. Inc. and our Clients. Our average technician receives a minimum of 4 months and/or 600 hours of one-on-one training, both on-the-job and in our histology lab. They are proficient in cutting and processing adipose and cartilage. Once the technician is able to consistently prepare a slide in 15 minutes or less, he/she will be awarded a certificate of completion.

In addition to proficiency in frozen tissue processing, the training curriculum consists of...

• extensive study of H&E stain chemistry
• microscope work
• basic histology and nomenclature
• exposure to surgery
• trouble shooting
• customer service efforts
• CLIA, OSHA, & HIPPA REGULATIONS

Our Mobile Mohs, Inc. Technicians come from all different backgrounds and have lived all over the United States. Technicians have advanced education, a uniform appearance, and great personalities. We pride ourselves in having a team atmosphere and superior slides at every office. Just look for the techs in blue!

W E K N O W M O H S
est. 1979

Coverslipping Techniques- Getting rid of air bubbles

Air bubble example

In the process of cover slipping, air bubbles can occur. This happens when air gets trapped in between the slide and coverslip. Here are a few tips for creating slides without bubbles and advancing your slide turn around time.

1- Take the slide out of the alcohol cup and quickly wipe the bottom and sides of the slide on a paper towel to remove excess alcohol.

2- Hold the slide lengthwise with 2 fingers

3- Apply 2-3 drops of cytoseal

4-Tilt slide at 45 degree angle towards you

5-Apply coverslip from bottom of slide and slowly ease coverslip down to avoid air bubbles

6-If bubbles still occur, squeeze them out applying light pressure with forceps to the coverslip and draw the bubbles to the end of the slide.

7- If you need to redo the slide, discard coverslip, re-dip slide in alcohol and repeat steps.


These tips should help decrease air bubbles. Practice is key and in no time you'll be making great slides!

Mobile Mohs Inc.

WE KNOW MOHS

What Makes a Successful Mohs Day?

Being a great Mohs Technician involves more than technical ability. You also need Accountability, Integrity, and Communication skills. These skills are key to creating a great team atmosphere between the Mohs Technician and the Mohs Physician.

Accountability- Don't just be on time, Be Early. If for some reason you're stuck in traffic or there is a delay, ALWAYS call ahead. It usually takes around 15 minutes for complete set up. Try to set up the same way each time so that every tool is in it's place. This allows for faster slide processing.

Make friends with the Mohs nurses. They can give you updates on where the Doctor is in their "Mohs loop." (whether they take all specimens first or check slides in between) When there is down time, always be a step ahead of the doctor. Clean off your used discs so that they are ready for extra levels, make slide labels, or refill your cry-ac with liquid nitrogen. Never leave the office until you ask the Mohs Surgeon if all patients are clear.

Integrity- Integrity means taking pride in your work and giving the patient and Mohs surgeon the best of your ability.

If in doubt about a specimen or anything Mohs related, ALWAYS ask. Did the specimen chunk out so you have to spend a few extra minutes to fix it? Let the Doctor know! They can use that time to do something else. Remember, You and the Doctor are on the same team so be honest when something happens. Check your work under the microscope. Keep your appearance and uniform clean. Always give your best.

Communication- This is one of the most important skills on a Mohs Day. Say hello to the Doctor and staff. Sometimes we forget that the Mohs Surgeon is a person too. Ask about their weekend, pets, upcoming trips... When they get to know you, it makes you familiar, and you will become a technician they will want to see around more often.

Let them know if a specimen is taking a little longer than usual. Ask questions if you aren't sure about how a specimen is oriented. How many sections do they prefer? Remember we want to make the Doctor feel as comfortable with us as possible.


Being a great Mohs Technician involves skill, accountability, integrity, and communication. With these skills you will be able to go from office to office and always leave a positive impact.

- Mobile Mohs -

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