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Mohs’ Micrographic Surgeryback to procedures

What is Mohs’ Micrographic Surgery?

Mohs’ micrographic surgery is a technique used to remove certain types of skin cancer. In Mohs’ surgery, the skin cancer is removed a layer at a time until all the cancer cells have been completely removed.  

The process involves:

  • A doctor removing a thin layer of the affected skin.
  • The removed layer is processed and examined under a microscope (takes approximately two hours).
  • If examination under the microscope shows the presence of cancer cells, it is possible to determine their precise location.
  • More tissue is then removed from the involved area and examined.
  • The process continues until there are no signs of any cancer cells left.

How long does it take?

The surgery itself may only take a short time however; the whole process can take several hours.

When is Mohs’ surgery used?

The majority of skin cancers can be treated by surgery alone without using this technique. Mohs’ surgery is particularly useful for:

  • Skin cancers of the face and sensitive areas such as the eye
  • Cancers where it is difficult to see the extent with a naked eye.
  • Cancers that have recurred.
  • Cancers which appear to have spread into the surrounding areas.
  • To preserve as much normal tissue as possible, in areas such as around the eye.

What are the alternatives to Moh’s Surgery?

            ·         Surgery  for removal of tumour

·         Radiotherapy: directing radiation at the cancer to destroy it.

·         Chemotherapy (anti-cancer drugs): applied to the skin

·         Cryotherapy - freezing treatment to destroy cancer cells.

·         Photodynamic therapy: Applying a special cream to the cancer under a dressing for 4-6 hours.  This destroys the cancer cells when a special light is shone on to it. It is often not suitable for areas around the eye.

Your doctor will talk to you about all the relevant options.   

What are the advantages of this procedure?

Mohs’ surgery sacrifices minimal healthy tissue while making sure that all the cancer has been taken away. It has an extremely high cure rate (over 95%)

What are the risks of this procedure?

There are no complications specific to this procedure.

Complications of any skin surgery include minor discomfort, wound infection, bleeding, scarring, numbness in the surrounding skin and nerve damage.

The vast majority of patients have this procedure without any problems.

Prior to Surgery

Please inform us of any medication you are taking and any illnesses in the past. In particular, if you are on any tablets which thin the blood (Aspirin or Warfarin, Plavix), as it is more likely to bleed. 

It is also important that we know if you are allergic to any medication or plaster.

The Day of Surgery

It is essential that you allow the whole day for this procedure. The length of time you can expect to stay will depend on the number of stages required. Most patients can expect to undergo at least 2 stages. A book may be helpful to pass the time and if possible bring a friend or member of your family to keep you company.  

The Procedure

The operation will take place in an operating theatre and you will be asked to undress and will be given a hospital gown to wear.

The lesion and surrounding skin are made numb with injections of local anaesthetic. Once the doctor is happy that the area is numb he will proceed with the operation. 

A temporary dressing will be applied to your wound while the removed tissue is prepared and examined. If you require further stages more local anaesthetic injections will be given as necessary before repeating the procedure.

There will be a wound following the completion of the Mohs’ surgery. The way it is closed will depend on the site and size of the wound. In some cases, it is best to leave the wound to heal by itself, but the majority will need some stitches, a skin flap or skin graft. The specialised reconstruction is carried out the next day by Mr Ahluwalia’s team.

When will I be able to go home?

Normally you should be able to go home soon after the operation is completed. Reconstruction is carried out by Mr Ahluwalia the next day. Eye dressings usually cover your eye or impair your vision. For your safety and that of others please arrange for a friend or relative to take you home after your operation. We advise you not to travel home alone. If you are planning to travel home by public transport we recommend you travel with someone so they can help you if you become unwell on the journey home. 

What should I do when I get home?

When you get home you should rest quietly for the first 12 hours for a small procedure or for 48 – 72 hours for a larger procedure. You will be given advice before you leave.

After Surgery

Will I experience pain when the local anaesthetic wears off?

The anaesthetic may last for two to three hours and will then start to wear off. There may be some mild pain which is relieved by simple pain killers such as paracetamol. The pain should not last more than 1-2 days. If you experience more severe pain or it lasts more than 2 days you should contact either your GP or the Ophthalmology Department for advice.

What should I do if the wound bleeds?

A small number of patients will experience some bleeding after their operation. It can usually be controlled by the use of pressure. You should take a gauze pad and apply constant pressure over the bleeding point for 15 minutes; do not lift up or relieve the pressure at all during that period of time. If bleeding persists repeat the pressure for another 15 minutes. If there is severe or persistent bleeding, please contact us or attend your local Accident and Emergency Department.

What should I do if the wound becomes infected?

A small red area may develop around your wound. This is normal and does not necessarily indicate infection. However, if the redness does not subside in two days or the wound becomes more painful or drains pus, antibiotics may be required

What should I do if the wound swells?

Swelling and bruising are very common following Mohs’ surgery, particularly when performed around the eyes. This usually subsides within four to five days after surgery and may be decreased by the use of an ice pack in the first 24 hours.

What should I do if the area remains numb?

At times, the area surrounding your operative site will be numb to the touch as the nerves in the skin have to be cut during surgery. This area of numbness may persist for several months and rarely may be permanent.

Will I have a scar?

Although every effort will be made to offer the best possible aesthetic result, skin surgery will leave a scar. The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with you and give you information sheets that will outline how to take care of your wound.

 If you have any questions please do not hesitate to ask Mr Ahluwalia.

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