Mohs micrographic surgery has the highest cure rate for skin cancer. Accurate and precise preparation of horizontal frozen sections in the laboratory is essential for the success of Mohs micrographic surgery. Key considerations in developing the Mohs surgery laboratory are careful planning and design, selection of proper equipment and supplies, training of laboratory personnel, adherence to regulatory standards of Clinical Laboratory Improvement Amendments (CLIA), and execution of an effective daily routine. The method of tissue processing used in the laboratory must yield optimal results for processing skin in an efficient manner.