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MOHS Diagnostic Service

The Cellular Pathology Department provides Solihull Dermatology Department with a trained Specialist Biomedical Scientist and a Consultant Histopathologist to enable microscopic examination and rapid diagnosis during the skin surgery.

The Mohs frozen section procedure is used for the examination of unfixed skin excisions of confirmed Basal Cell Carcinoma (BCC) and occasionally Squamous Cell Carcinoma (SCC) occurring in areas that are clinically difficult to operate on. This includes the face, ears and neck areas and occasionally scalp region.

The procedure relies on frozen section technique, stepped levels and specimen mapping to assess the surgical margin of a specimen. Where tumour is still present at the margin, further tissue is taken and the procedure repeated until all surgical margins are free from tumour. The procedure allows for a surgical margin clearance of 0.5mm and is considered tissue sparing. This also allows for improved healing and reduced scarring in patients undergoing this procedure. Occasionally it may be necessary to fix the specimen in 10% neutral buffered formalin for processing at a later date at the laboratory. In these cases the specimen and request form must be transported to Heartlands Hospital labelled URGENT MOHS SPECIMEN.Healthy tissue is spared and recurrence is extremely rare using this technique.

Information regarding the surgery is supplied to the patient by the Dermatology Department.

MOHS Clinics run on Mondays and Wednesdays between 09:00 and 17:00.

  • For further information please contact the Solihull Dermatology department on 0121 424 5147
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    Edoxaban Assay

    Edoxaban is one of the direct oral anticoagulants, exerting an anticoagulant effect by inhibiting activated factor X.

    Changes in the prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) may be observed in patients on therapeutic edoxaban doses. However, these changes tend to be small, unpredictable, and highly variable, so clinicians should not use these markers to monitor the anticoagulant effects or titrate the dose of edoxaban (Plitt A, Giugliano RP. Edoxaban: review of Pharmacology and key phase I to III clinical trials. J Cardiovasc Pharmacol Ther. 2014;19(5):409–416).

    Urgent requests should be discussed with the laboratory prior to receiving the sample.

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    Clinical Decision Limits

    Phoning limits for biochemistry tests are as follows:

    Decision limits for phoning

      Below Above Units
    Sodium 120 150 mmol/L
    Potassium 3 6.5 mmol/L
    Urea   30 mmol/L
    Creatinine   500 umol/L
    Glucose 2.5 20 mmol/L
    Calcium adjusted 1.8 3.5 mmol/L
    Magnesium 0.4   mmol/L
    Phosphate 0.3   mmol/L
    AST   700 U/L
    ALT   400 U/L
    Total CK   500 U/L
    Amylase   600 U/L
    TBA   20 umol/L
    Iron   70 umol/L
    Total bilirubin   225 umol/L
    Carbamazepine   25 ug /mL
    Digoxin   2.5 ng/mL
    Theophylline   45 mg/L
    Phenytoin   20 mg/L
    Phenobarbitone   70 mg/L
    Lithium  <0.2 >1.5 mmol/L
    Valproate   100 mg/L
    Cyclosporin A   200 ug/L


    phoned with other abnormal results

    Salicylate   20 mg/L
    Paracetamol   10 mg/L
    Ammonia All phoned    
    Lactate All phoned    
    beta-HCG All phoned    
    progesterone All phoned    
    CSF glucose All phoned    
    CSF protein All phoned    
    NNU results All phoned    

    Read more: Clinical Decision Limits

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    Haematinic Guidelines

    HEFT Pathology Guideline Investigation and Referral Pathways for Anaemia in Primary Care

    Produced by:

    Dr Sukhbir Kaur (Senior Clinical Biochemist)

    Approved by:

    Dr Kartsios Charalampos (Consultant Haematologist)


    Dr Marcus Mottershead (Consultant Gastroenterology)

    This guidence covers the following areas

    1. Anaemia Testing in Adults

    2. Iron Deficiency Anaemia Testing in Adults

    3. Iron Deficiency Anaemia Treatment and Monitoring Advice

    4. Vitamin B12 Deficiency Testing, Treatment and Monitoring

    5. Folate Deficiency Testing, Treatment and Monitoring Advice

    6. Renal Anaemia Testing in Adults

    biochemistry, haematology, haemainics

    Read more: Haematinic Guidelines

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    Tumour Marker Use in Primary Care

    In the last 5 years requests for tumour marker tests from Primary Care have more than doubled. This high use in Primary Care is worrying because the majority of tumour markers (eg. CEA, CA19-9) are neither specific nor sensitive enough for use in the diagnosis of malignancy. See this link for a summary of the main tumour markers, their uses and limitations.

    The main use for tumour markers is in monitoring disease progression, treatment or recurrence of a histologically diagnosed cancer. A recent audit of Primary Care requests for tumour markers found that only 9% of CEA and 4% of CA19-9 were requested for these reasons; the rest being for non-specific symptoms.

    In contrast to the above, CA125 and PSA do have use in diagnosis of their related cancers, however it should also be noted that these are still only a diagnostic aid and should be used with caution as both can be raised in a number of other benign conditions (see table). Please click the relevant links below of links to guidelines relating to their use in Primary Care.

    CA125 link https://pathways.nice.org.uk/pathways/ovarian-cancer

    PSA link https://www.gov.uk/guidance/prostate-cancer-risk-management-programme-overview

    For symptoms and referral guidelines of other malignancies see the NICE Suspected Cancer Recognition and Referral guidelines. http://pathways.nice.org.uk/pathways/suspected-cancer-recognition-and-referral

    You can also use the search bar or test database on this website to find more specific information on the use of each tumour marker.

    Tumour marker

    Main application

    Other tumour elevations

    Other limitations


    Monitoring colorectal adenocarcinomas

    Breast, lung, gastric, mesotheliomas, oesophageal and pancreatic

    Raised in smokers

    Raised in other benign renal, liver, lung or GI disease

    Poor sensitivity in early disease and may be absent/low in poorly differentiated tumours


    Monitoring pancreatic carcinoma


    Raised in obstructive jaundice, cholestasis, cirrhosis, pancreatic hepatitis and non-malignant GI disease.

    Not present in those negative for the Lewis blood group determinant.


    Monitoring ovarian carcinoma


    Raised in patients with ascites, pleural effusions or free fluid in the pelvis

    Raised in patients with congestive heart failure

    Raised in benign renal and liver disease and other adenocarcinomas

    Mildly raised in menstruation and the first two trimesters of pregnancy

    Can be raised in endometriosis


    Monitoring breast cancer

    Lung, colon, ovary

    Raised in benign liver, breast, ovarian disease


    Diagnosis and monitoring of hepatocellular carcinoma and germ cell tumours

    Gastric and other GI (oesophageal, pancreatic)

    Raised in pregnancy and neonates

    Raised in benign liver disease


    Diagnosis and monitoring of prostate carcinoma


    Also elevated in benign prostatic conditions

    Increases with age (as prostate size increases)

    Elevated in UTI, catheterisation, prostatitis or other prostate manipulation


    Diagnosis and monitoring of germ cell tumours and gestational trophoblastic neoplasia


    Raised in pregnancy

    Transiently elevated with cannabis use


    Diagnosis and monitoring of germ cell tumours


    Elevated in cardiac disease and benign liver disease

    Elevated in some anaemias relating to non-malignant disease

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    Copyright heftpathology 2013, 2014, 2015, 2016, 2017, 2018

    HTA licence number is 12366

    Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

    The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
    Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

    For further information contact Louise Fallon, Quality Manager, 0121 424 1235

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