The Fast Raman device is a new tool developed as a potential alternative to frozen section histology for margin assessment during Mohs micrographic surgery of basal cell carcinoma(BCC). We describe the integration of the device into the clinical pathway and present the first results after investigating skin specimens excised from the head and neck areas. Tissue analysis was fixed to 30 minutes and covered >95% or the surgical margin (including deep andepidermal margins). The preliminary results of the Fast Raman analysis agreed with histology for 84% of cases: 58 out of 67 BCC-negative and 7 out of 10 BCC-positive layers. The false-positive diagnoses were related to incipient hair follicles or inflammation. For the three discordant layers considered BCC-positive by frozen section histology, it is uncertain whether the disagreements were caused by a failure to detect BCC by the Fast Raman device or byhistology miss-diagnoses caused by tissue processing. The Fast Raman device has the potential to provide important benefits to Mohs surgery byreducing the duration and costs of tissue processing and by decreasing diagnosis subjectivity and inter-user variability. The successful integration in the clinical pathway is an important step towards a larger diagnostic test accuracy study.