A single‐institution retrospective evaluation of Mohs incision angles and histopathologic specimen quality,
Sherry H. Yu MD  Suzanne M. Olbricht MD  Jeffrey B. Tiger MD
First published: 17 July 2019 https://doi.org/10.1111/ijd.14591
Funding: None.
Conflicts of interest: None.
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Abstract
Background
Traditionally, Mohs layers are excised using a beveled incision to facilitate tissue flattening for tangential sectioning. Some surgeons perform non‐beveled incisions; however, these specimens may be harder for the histotechnician to process. Limited data exist comparing slide quality between these techniques.

Methods
Retrospective review of cases performed by two Mohs surgeons (surgeon 1 = non‐beveled incision; surgeon 2 =  beveled incision) using different incision angles between June 2014 and December 2016. Daily histopathologic slide quality assessment scores (maximum score = 5, minimum score = 1) of the day's first case were compared.

Results
About 536 slides (surgeon 1 = 277, surgeon 2 = 259) were evaluated from 2,825 cases. Mean quality assessment scores were similar between surgeons (4.89 and 4.86; P = 0.31) with missing or folded epidermis being the most commonly reported issue for both surgeons.

Conclusion
Similar slide quality can be achieved via both beveled and non‐beveled Mohs cutting angles. While more relaxing incisions may be necessary to optimize tissue flattening with non‐beveled incisions, there is no associated increased loss of epidermal margins. The potential benefits of non‐beveled incisions, such as minimizing tangentially cut adnexal structures and creating vertical wound edges optimized for repair, may offer an alternative technique with positive clinical implications.