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MOHS
Other Surgical Services:
What is MOHS Micrographic Surgery?
MOHS surgery is a specialised surgical technique primarily used for the treatment of skin cancer. The technique is named after Dr. Frederic Mohs, who developed the procedure in the 1930s. MOHS surgery is particularly useful for treating skin cancers that are located in areas where preserving healthy tissue is essential, such as the face, ears, or hands. It is also recommended for skin cancers that are large, aggressive, or have recurred after previous treatments.
How does it work:
MOHS micrographic surgery involves the systematic removal and examination of thin layers of tissue to precisely target and remove cancerous cells while sparing healthy tissue. This technique allows for the highest possible cure rate while minimizing the impact on surrounding healthy tissue. It is particularly effective for skin cancers with ill-defined borders, high recurrence rates, aggressive growth patterns, or those in anatomically challenging locations.
TREATED ON
MOHS Micrographic Surgery is commonly employed to treat two primary types of skin cancer:
Basal Cell Carcinoma (BCC):
This is the most common type of skin cancer, typically found on sun-exposed areas of the skin. MOHS surgery is often used to treat BCC because it offers a high cure rate and minimizes the removal of healthy tissue, which is particularly important for cancer occurring in cosmetically sensitive areas or for tumors with aggressive features.
Squamous Cell Carcinoma (SCC):
SCC is another common type of skin cancer that often arises from sun-damaged skin or from precancerous lesions like actinic keratoses. MOHS surgery is frequently utilized for SCC treatment, especially for high-risk or recurrent tumors, large tumors, or those located in critical anatomical regions.
It's important to note that MOHS surgery is not appropriate for all skin cancers. Other treatment modalities, such as excisional surgery, radiation therapy, or topical treatments, may be recommended for different types or stages of skin cancer. The suitability of MOHS surgery as a treatment option will be determined by a dermatologist or surgeon based on various factors, including the type, size, location, and characteristics of the skin cancer.
MOHS Micrographic Surgery Procedure
MOHS surgery is a specialised surgical technique used to remove skin cancer with high precision. The procedure typically involves the following steps:
1. Local anaesthesia:
Prior to starting the procedure, the patient is given a local anaesthetic to numb the area where the cancer is located. This helps to minimise any pain or discomfort that the patient may experience during the surgery. In some cases, the surgeon may also offer a sedative to help the patient relax during the procedure.
2. Removal of visible cancer:
The surgeon first removes the visible cancer using a scalpel. This involves cutting away the cancerous tissue along with a small margin of healthy tissue around it. The removed tissue is then examined under a microscope to confirm that it is cancerous and to identify the type of cancer cells present.
3. Mapping of tissue:
The surgeon then maps the tissue to identify where the cancer is located and where it has spread. This involves dividing the cancerous tissue into sections and marking each section on a map. The map is used to guide the removal of additional tissue during the procedure.
4. Tissue removal:
The surgeon removes a thin layer of tissue from the area where the cancer was located, along with a small margin of healthy tissue. This is done using a scalpel or a specialised surgical tool called a dermabrader. The removed tissue is then processed and examined under a microscope to check for the presence of cancer cells.
5. Examination of tissue:
The removed tissue is examined under a microscope by a specialised technician called a histotechnologist. This involves processing the tissue, staining it with special dyes, and then examining it under a microscope to look for cancer cells. This process can take up to an hour or more depending on the size of the tissue sample.
6. Repeat tissue removal:
If cancer cells are present in the margins, the surgeon removes another layer of tissue and examines it under a microscope. This process is repeated until all the cancer cells have been removed. The surgeon continues to remove tissue in this way until no cancer cells are found in the margins. This may require several rounds of tissue removal, but it ensures that all of the cancerous tissue is removed while minimising the removal of healthy tissue.
7. Closure of wound:
Once all the cancer cells have been removed, the wound is closed using stitches or a skin graft. The type of closure used will depend on the size and location of the wound. The surgeon will typically use techniques that minimise scarring and promote healing.
8. Follow-up care:
The patient is instructed to care for the wound at home and to follow up with the surgeon to monitor for any signs of recurrence. The patient may need to return for additional check-ups and monitoring over the coming weeks and months to ensure that the cancer has not returned. The surgeon will also provide guidance on how to care for the wound and manage any pain or discomfort.
BENEFITS OF MOHS
MOHS surgery offers several benefits over other surgical techniques for the treatment of skin cancer. Some of these benefits include:
High cure rate:
MOHS surgery has a very high cure rate for many types of skin cancer. This is because it allows for precise removal of cancerous tissue, while preserving as much healthy tissue as possible. The procedure has a cure rate of over 99% for some types of skin cancer.
Minimises the removal of healthy tissue:
MOHS surgery is a tissue-sparing technique that aims to remove only the cancerous tissue, while preserving as much healthy tissue as possible. This is particularly important when treating skin cancer in cosmetically sensitive areas, such as the face, where the preservation of healthy tissue is crucial for a good cosmetic outcome.
Offers immediate results:
During the MOHS surgery procedure, the surgeon is able to examine the tissue under a microscope in real-time to ensure that all of the cancerous tissue has been removed. This allows the surgeon to immediately assess the completeness of the removal and determine if additional tissue needs to be removed. As a result, the patient can often have the cancer removed in one visit, without the need for additional surgery or waiting for lab results.
Reduces the need for extensive reconstruction:
Because MOHS surgery preserves healthy tissue, it can often reduce the need for extensive reconstruction or skin grafting. This can result in a faster and smoother recovery for the patient.
Effective for large or recurring skin cancers:
MOHS surgery can be particularly effective for large or recurring skin cancers, where other treatment options may not be as successful. Because the surgeon is able to remove the cancerous tissue layer by layer, they can ensure that all of the cancer cells have been removed, even in cases where the cancer has grown deep or has previously been treated and recurred.
Overall, MOHS surgery is a highly effective, precise, and safe surgical technique that offers several benefits for the treatment of skin cancer
BEFORE & AFTER
Below shows the process and results of Dr Paul's MOHS work:
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Before
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Recovering Process
After
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Before
Recovering Process
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After
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Case Studies
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