A commentary published online October 10, 2026, in the Journal of the American Academy of Dermatology argues that Mohs laboratories should optimize liquid nitrogen handling practices based on laboratory-specific considerations rather than convenience alone.

In the piece, titled "Optimizing Liquid Nitrogen Handling in Mohs Laboratories: Considerations Beyond Convenience," author Ji-Long Shi examines the practical decisions Mohs units face when storing, transporting and dispensing liquid nitrogen for tissue processing.

Why does liquid nitrogen handling matter in Mohs surgery?

Mohs micrographic surgery depends on high-quality frozen tissue sections. Liquid nitrogen is the fastest freezing medium available to Mohs histotechnicians, and the quality of the freeze directly affects section integrity, staining quality and, ultimately, the accuracy of margin assessment for skin cancer excision.

Yet liquid nitrogen is also a cryogenic hazard. It poses risks of cold burns, asphyxiation in poorly ventilated spaces, and pressure buildup in improperly vented storage vessels. How a laboratory stores, moves and dispenses it therefore touches both diagnostic quality and occupational safety.

What considerations go beyond convenience?

The commentary's framing — "considerations beyond convenience" — signals its core argument: laboratories often default to the easiest handling method, such as a single shared storage dewar or informal transport practices, without systematically evaluating alternatives against their own workflow, volume and facilities.

For a high-volume Mohs practice, the calculus around liquid nitrogen logistics differs substantially from that of a low-volume unit. Storage capacity, refill frequency, distance between storage and processing stations, ventilation and staff training all shape which handling protocol is optimal for a given laboratory.

What should practices take from it?

The article appears in JAAD, the field's highest-impact journal, which gives its practical guidance weight for fellowship directors, lab managers and practices auditing their frozen-section workflows. Readers involved in Mohs laboratory accreditation or quality improvement programs will find the full argument in the online-first edition.

As Mohs volume continues to grow across the United States, commentaries like this one push laboratories to formalize handling decisions that have often been made informally — a shift that could standardize both technician safety and frozen-section quality across practices.