Single “Pac-Man” Sectioning is More Efficient Than Bisected Sectioning of Mohs Surgery Specimens
This study demonstrates that adopting the "Pac-Man" whole specimen sectioning method for Mohs micrographic surgery significantly reduces tissue processing turnaround time compared to traditional bisected sectioning without compromising slide or specimen quality, thereby improving patient care and operational efficiency.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Skin cancer is a common threat, but for certain types, a specialized procedure called Mohs micrographic surgery offers a precise way to remove the disease while saving as much healthy tissue as possible. In this operation, a surgeon removes a thin layer of the tumor and immediately sends it to a laboratory. There, a skilled technician freezes the tissue, slices it into extremely thin sections, and places them on glass slides for a pathologist to examine under a microscope. The goal is to see if any cancer cells remain at the edges of the removed piece. If cells are found, the surgeon returns to remove another layer from that specific spot, repeating the cycle until the area is clear. The speed and clarity of this process are vital, as patients wait in the operating room for the results before the surgery can be finished.
For years, many medical centers have used a specific method to prepare these tissue samples, known as bisecting. This involves cutting the removed piece of skin in half before processing it. While this technique helps flatten larger or oddly shaped pieces of tissue to make them easier to read, it adds an extra step to the workflow. At the University of Wisconsin, researchers noticed that this extra step might be slowing things down, even for small, simple tumors that did not strictly require it. They began to wonder if a different approach, where the entire piece of tissue is processed as a single unit, could be faster without sacrificing the quality of the medical examination.
A team of researchers at the University of Wisconsin–Madison set out to test this idea by comparing the traditional half-cut method against a technique they call "Pac-Man" sectioning. In this newer approach, the entire removed tissue sample is placed on a block and sliced in one continuous motion, much like the shape of the classic video game character, leaving a small gap where the surgeon can map the location of any remaining cancer. The team focused on small, flat tumors that were less than one and a half centimeters in size, as these are the types of lesions most suitable for this single-piece method. They collected data on 126 such cases over a two-month period in early 2026, carefully timing how long it took from the moment the tissue arrived in the lab until the slides were ready for the surgeon to view.
The results showed a clear difference in speed. When the lab used the single-piece Pac-Man method, the average time to prepare the slides was just over twenty-six minutes. In contrast, the historical data for the traditional half-cut method showed an average time of nearly thirty-six minutes. This meant the new method shaved off roughly nine minutes from the process for each patient. The researchers also asked the surgeons to rate the quality of the slides and the tissue samples. They found that the faster method did not produce lower-quality images; in fact, nearly all of the slides were rated as acceptable or better, with more than ninety percent of the tissue samples receiving the highest possible score. The surgeons reported that the single-piece slides were just as clear and useful for making medical decisions as the older, slower method.
Beyond the clock, the study highlighted how this change could ease the workload for the laboratory staff. By processing the tissue in one piece rather than cutting it in half, the technicians performed fewer steps and used fewer materials to get the same result. The researchers noted that this efficiency could lead to less waste and a smoother flow in the clinic, allowing patients to spend less time waiting in the operating room. While the study was limited to specific types of small tumors and relied on the skill of the technicians performing the work, the findings suggest that for the right cases, the single-piece approach is a viable and faster alternative. The team concluded that adopting this method could improve the experience for patients and staff alike, offering a more efficient path to clearing skin cancer without compromising the careful examination that makes Mohs surgery so effective.
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