Surgical pearl: digital imaging for mapping Mohs surgical specimens.

From the Division of Dermatology, Geisinger Medical Center. Reprints not available from authors. J Am Acad Dermatol 2000;43:712-3. Copyright © 2000 by the American Academy of Dermatology, Inc. 0190-9622/2000/$12.00 + 0 16/74/107957 doi:10.1067/mjd.2000.107957 M ohs micrographic surgery requires precise mapping of tissue specimens.1 In most instances the specimens are round, oval, or crescentic, and diagrams can be easily drawn by the Mohs surgeon. Complex tissue specimens, however, may be more challenging to accurately diagram by hand. We describe the use of digital imaging to precisely map such specimens. Using a Sony Mavica MVC-FD7 digital camera, we photographed the surgical specimen on a white nonadhering dressing and recorded it into an image file on a 3.5-inch floppy disk. The image was then imported into Microsoft Word 97 and converted to gray scale using the image control application. Image brightness was increased, using the photo tool function, to a lighter shade that allowed subsequent drawing on the diagram to be seen. Image size was then adjusted to approximate the actual size of the specimen (Fig 1). The printed image was then used to precisely map tissue sectioning (Fig 2). A dotted line is drawn on the map to indicate which edge is dyed (not shown in Fig 2). We have found that the use of this technique does not delay the Mohs procedure. Our histotechnologists produce the image in approximately 2 minutes and have no special training other than proficiency in Microsoft Word 97. In our practice there is no extra cost to using this method of mapping because the equipment is being used for Mohs surgery. The equipment needed includes a personal computer, printer, and digital camera. Microsoft Word 97 software is commonly included with purchase of a personal computer. If purchased separately, this software costs approximately $300. The digital camera we use currently costs $500. Digital imaging is emerging as a useful tool in dermatology.2 The technique we describe allows the surgeon to easily design an accurate map of more complex tissue specimens during Mohs micrographic surgery. PEARLS