Mohs Surgery

The principles of Mohs surgery was developed by a general surgeon, Frederic E. Mohs.

Mohs surgery, also referred to as Mohs Micrographic Surgery, is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.

• The removed tissue is immediately processed by the Mohs surgeon in an on-site Mohs histological laboratory, while you return to your hospital ward or wait in the waiting room.
• The specific method of processing, allows tissue slides to be produced that show the whole, complete cut surface around the tumour. These slides are then examined by the Mohs surgeon and any remaining tumour will be indicated very accurately, also including the exact area on the tumour wound where the tumour is still present.
• You will then return to the day theatre or procedure room where the process is repeated but only on the area of the remaining tumour, leaving the healthy tumour-free area of the wound untouched.
• As soon as the Mohs surgery confirms the skin cancer to be completely removed, a specialist reconstructive surgeon or the Mohs surgeon repairs the defect where the cancer was removed, almost always on the same day.

Yes. Following a biopsy, your skin cancer may no longer be visible. However, more tumour cells may remain in the skin that are not visible to the naked eye and can continue to grow if they are not removed.  In other words, what appears to be a tumour removed by biopsy, will in all likelihood reappear and will then require more extensive surgery.  Tumours left untreated have the capability to spread further into the skin and (although rare) cause damage to nearby organs and lymph nodes.

•  Mohs Surgery has the highest success rate.
• Larger cancers, cancers with more aggressive growth patterns, cancers recurring following previous treatment, incompletely removed cancers, or cancers involving vital areas such as nose, ears, lips and eyelids should be treated with Mohs Surgery.
• Traditional surgery removing the cancer with a wide rim of healthy surrounding tissue has the limitation that it is essentially “blind,” meaning that the tumour can be left behind.
• To reduce that risk, the surgeon must often sacrifice additional surrounding healthy tissue, leading to larger defects and reconstructions.
• An alternative is to have a pathologist on hand in theatre to perform a few random tissue sections to assist the surgeon in determining if the tumour is fully removed. Although it improves on the cure rate of a “blind” excision, the whole cut surface is not evaluated but only random areas, which means that the tumour can still be left behind.
• The Gold Standard surgical method worldwide for the most effective removal of skin cancer, is Mohs Surgery. With this technique, in most cases performed under a local anaesthetic, the tumour is removed with a thin layer of surrounding healthy tissue.

Although Mohs Surgery tends to have the highest cure rate (99.5% for new skin cancers and 95% for recurrent skin cancers), unfortunately, no cancer treatment or surgery has a 100% cure rate.

• A skin cancer treated with Mohs Surgery may (very seldom) reoccur or a new cancer may arise in the same or adjacent area after Mohs or other surgery.
• Some skin cancers are more aggressive than others and need additional treatment and closer follow-up.
• Follow-up appointments with your referring dermatologist are very important, especially in the first few years after surgery.

If you have completed treatment, follow-up visits with you referring dermatologist at regular intervals are very important.

• People who have had skin cancer are at high risk of developing another skin cancer in a different location, consequently, close follow-up is of the utmost importance.
• It’s also very important to curb sun exposure as far as possible and vigilantly applying sunscreen with a high SPF when your skin is exposed to the sun as the sun can increase your risk of new skin cancers.

• Today, Mohs Surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomas and Squamous Cell Carcinomas (BCCs and SCCs), the two most common skin cancers.
• Lentigo Maligna (melanoma-in-situ), can be treated with a variation of the Mohs technique as well.

Too much unprotected exposure to ultraviolet (UV) radiation from sunlight or tanning beds and lamps are the main contributing factor ro skin cancer.

Even though fair-skinned people who easily suffers from sunburn (due to infrequent exposure to the sun), with natural red or blond hair, are more at risk to develop skin cancer.  Skin cancer can affect anyone,both men and women.

Basal cell carcinoma is the most common type of skin cancer and its appearance is often a small “pearly” but that looks like a flesh-coloured mole or pimple that doesn’t go away.  Sometimes, these growths can look dark or one may see shiny or red patches that are slightly scaly.

Basal cell carcinomas hardly ever invade or spread to the lymph nodes.

A Squamous cell carcinoma is the second most common type of skin cancer and its appearance is often a hard, scaly bump or scaling patch and may be mistaken for a wart or patch of dry skin.

Squamous cell carcinoma can occasionally spread into the lymph nodes and internal organs.  An increased risk of spreading is also seen in patients who are immunosuppressed, such as organ transplant patients.