Laboratory Assistive Personnel in Mohs Micrographic Surgery: A Survey of Training and Laboratory Practice T. MINSUE CHEN, MD, Ã RUNGSIMA WANITPHAKDEEDECHA, MD, MA, MSC, y DARREN E. WHITTEMORE, DO, z AND TRI H. NGUYEN, MD Ã BACKGROUND The success of Mohs micrographic surgery (MMS) is contingent on high-quality frozen tissue sections for histologic interpretation. Laboratory assistive personnel (LAP) are central to this process, but their training and tissue processing techniques are neither standardized nor certified for competence. OBJECTIVE To evaluate processes used to train and laboratory techniques practiced by LAP. Letters were mailed to Mohs surgeons with a Web link to an online survey for LAP to complete. RESULTS Response rate was 24%. Responders primarily received training on the job, but not from the surgeon. On-the-job training from other LAP was perceived to be the most helpful, and textbook to be the least helpful. On average, survey responders felt it took several months to become proficient. Wide variations in laboratory practice were noted for histology laboratory and Mohs tissue processing tech- niques and for quality assurance. Differences in training and practices were noted between certified and noncertified LAP. CONCLUSION Patient care may be compromised because of variable practice of laboratory techniques, quality assurance, and quality control. Standardization of LAP training, along with demonstration and maintenance of competency, may be necessary to ensure the integrity of the MMS technique. The authors have indicated no significant interest with commercial supporters. M ohs micrographic surgery (MMS) is a specialized technique to treat cutaneous malignancies. 1 The advantages of MMS over other techniques include meticulous mapping and orien- tation of excised tissue, complete surgical margin evaluation, higher cure rates, and preservation of tissue in cosmetically sensitive areas. The success of MMS is contingent on high-quality frozen tissue sections for histologic interpretation; well-trained and experienced laboratory assistive personnel (LAP) are central to this process. 2,3 Congress passed Clinical Laboratory Improvement Amendments of 1988 (CLIA) to develop compre- hensive, quality standards for laboratory testing to ensure the accuracy, reliability, and timeliness of patient tests performed. 4 CLIA requires that a facility or laboratory be appropriately certified for each test performed based on the level of complexity of the test. Every physician who performs MMS is required to possess a high-complexity CLIA certifi- cate; without the appropriate certificate, the physi- cian will be denied reimbursement for Medicare carriers. 5 CLIA personnel requirements pertain to individuals (physicians, supervisors, histotechnolo- gists, histotechnicians, and other testing personnel) who interpret the tests (render a histologic diagnosis) but not the LAP who have been delegated to prepare test materials (tissue processing and slide prepara- tion) (CLIA Regulations, Part 493: Laboratory Re- quirements, Subpart MFPersonnel for nonwaived testing, Sections 493.1441 through 493.1495). De- spite these published CLIA regulations, it is likely that compliance with or even ignorance of these & 2009 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc.  ISSN: 1076-0512  Dermatol Surg 2009;35:1746–1756  DOI: 10.1111/j.1524-4725.2009.01287.x 1746 Ã Department of Dermatology, MD Anderson Cancer Center, University of Texas, Houston, Texas; y Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; z Department of Pathology, Wilford Hall Medical Center, Lackland Air Force Base, Lackland, Texas