Log Book Abbreviations

One of our responsibilities as Mohs techs is to make sure the slide labels and logbook information is correct and CLIA compliant. Here are the most commonly abbreviated orientation and directional terms:

The following terms should never be abbreviated in the logbook or label, even if its written shorthand on the map:

Less common directional terms (eg. pareital, distal, radial, ulnar, dorsal, etc) should be written out as well. If you see any abbreviated term on a map that you are unsure of, ask the staff what it stands for and write out the whole word  in the logbook/labels.

TROUBLESHOOTING: Cry-Ac

Problem: Trigger handle sticks open, won't stop spraying.
Solution: Rotate the trigger to the side until the next time you need to use it. If this doesn't work, depressurize it by unscrewing the top.

Problem: Excessive leaking/hissing from the relief valve.
Solution: The exterior of the Cry-Ac has too much frost built up. Try pushing down on the relief valve and twisting it back and forth to break up the ice. You can also clean the frost with alcohol and gauze.

Problem: Sprays only intermittently.

Solution: The liquid nitrogen supply may be contaminated with water. Check for cloudy droplets of ice.

Problem: Does not spray

Solution A) Trigger is too close. Twist the round silver part to adjust the trigger position.

Solution B) The Cry-Ac has been over-filled and there is insufficient air space inside the bottle to create an adequate build up of pressure required to spray. Do not fill past this line.

Solution C) Check that the rubber gasket is in place inside the cover and is not split or missing.

Solution D) The position of the trigger should be directly to the left or right of the delivery tube.

HOW TO PREP AND CUT: Biopies

Occasionally, the doctor may find a suspicious spot and will want to do a biopsy before going ahead with Mohs. Instead of the usual horizontal sectioning, biopsies are sectioned vertically. You may have heard it referred to as "bread-loafing."

A biopsy can reveal whether there are any cancer cells present and can help differentiate between the various types of cancer. It will not, however, tell you WHERE those cells are or if the margins are clear. 

There is no need to bisect or ink the tissue because you will be cutting through the entire piece. Squeeze some OCT onto a disc on the cold bar. Once the base of the OCT has turned white, hold the biopsy specimen vertically in the OCT until it's frozen enough to stand up on its own. Add more OCT on top so that none of the tissue is exposed.

Don't worry about lining it up perfectly, just eyeball it and do your best. The FBX slide must show sections from the entire specimen, so you'll be cutting through quite a bit of tissue in between the sections that you actually pick up. Advance the wheel manually several times then use the hand-crank wheel to discard a few regular cuts before picking up a nice wafer.

As always, be careful that the tissue sections are not placed on top of OCT from a previous section or it will all wash off in the stains. There won't be any tissue left to do a recut!

Repeat until you have at least 8 sections and you've cut through the entire biopsy specimen. Stain as usual.

Large Biopies
If you get a biopsy that's bigger than usual, you can save time by bisecting it and placing the halves vertically on a slide. Freeze the back of the slide and make a regular mount as if you're processing a normal mohs specimen. Since the piece is now essentially half the depth, you won't waste as much time cutting through the specimen to get your 8-10 sections.