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.

Slide Review: Thick skin and sun damaged skin

Thick and/or sun damaged skin will appear as a translucent layer of cells outside the epidermis. This section shows scabby, sun damaged tissue, so the layer of cells is rough and uneven. In the mid dermis, the grayish/lavender area is most likely actinic elastosis, or the accumulation of abnormal elastic tissue in the dermis, also a result of sun damage.

This next section shows the thick skin found in the palms of the hand or the soles of the feet. Note that even though the image (courtesy of http://www.dartmouth.edu) points out the "thickened layer of squamous cells," it is not referring to SCC. Healthy squamous cells are a normal part of the superficial epidermis. The outermost squamous cells are heavily keratinized, creating a thick layer of dead cells that protects our hands and feet. 

For comparison, here is a section of normal tissue only a thin layer of dead squamous epithelial cells.

Slide Review: Water in the slide

At the end of staining, tissue sections must be fully dehydrated by alcohol before applying Cytoseal. If you rush the process and leave water mixed with the alcohol and glue, the tissue will have strange dark flecks in it. Notice how the tissue in the far lower right corner of this picture is not contaminated as much. The cytoseal was probably dropped directly on that area of tissue.

You will also notice what looks like streams of bubbles. Since cytoseal is toluene-based and toluene is insoluble in water, any water left on the slide will create this cloudy mess of bubbles.

Solution: Recoverslip. Slide off the coverslip. Give the slide a few good swishes in the alcohol, a few drops of glue, and a brand new coverslip. 

Moisture will damage the cryo paint

This cryo/truck was parked next to the sprinklers and the water must have soaked into the blanket overnight. At the job the next morning, the cryo looked like this. I'm not sure how it's any different from driving through heavy rain on the way to or from a job but for whatever reason, those sprinklers really did a number on the paint job.

I imagine car washes will do the same thing eventually, so if it's not too much of a hassle:

-Leave the cryo at home when you get your truck washed.
-If there's nowhere to put it at home, you can drop the cryo off at the office and pick it up afterwards.
-You could also just leave the cryo on the truck and wash the truck at home, being careful not to get cryo wet.