Mohs Micrographic Surgery for Skin Cancers

Mohs Micrographic Surgery for Skin Cancers?

This is a specialised form of surgery to remove certain skin cancers and is also called Mohs’ surgery after the doctor who developed it. Your surgeon removes the visible portion of your tumour and then removes further tissue that may have cancer cells, one layer at a time. This tissue is examined under a microscope while you are still in the clinic. If it contains cancer cells, another layer of tissue is removed and examined. This is repeated until all the cancer cells have been removed.

Your doctor may have recommended Mohs’ surgery because:

1. your skin cancer has returned;
2. your tumour was previously removed, but some cancer cells remain;
3. your cancer is in an area where we want to reduce the amount of healthy tissue we remove, such as on your eyelids, nose, ears or lips; or.
4. the edges of your tumour are not well defined.

Why should I have micrographic surgery?

Other types of surgery for skin tumours rely on the surgeon being able to see the extent of the cancer, which can either lead to a large wound and scar if too much healthy tissue is removed or too little tissue being removed and the cancer returning. Micrographic surgery maximises the chances that your tumour will be completely excised (removed) while minimising the amount of surrounding normal skin needing to be taken away.

What happens during Mohs’ surgery?

There are several stages to Mohs’ surgery. First, your doctor will inject the area where your tumour is, with a local anaesthetic. This numbs the area, so you will not feel any pain during surgery. It will not put you to sleep, so you will remain awake throughout the surgery.

We may also use anaesthetic eye drops if your tumour is near your eye.

Once the anaesthetic has taken effect, the visible (also called the clinically evident) part of the tumour is removed, along with a small margin of normal skin tissue. This tissue is taken to a laboratory where your doctor will be able to look at it under a microscope to check for cancer cells. This takes about 40-60 minutes, so a temporary dressing is applied to your wound and you are asked to sit in the waiting area.

If cancer cells are present in this tissue, you will be brought back into operating room and more tissue will be taken away and examined under the microscope. This will be repeated until all the tumour cells have been removed.

The local anaesthetic lasts for about 2 hours, and can be ‘topped up’ if needed. Because of the nature of this surgery, we are unable to tell you exactly how long your surgery will last. Generally speaking, the entire process does not last more than 2 hours..

What happens after the procedure?

Once all the tumour cells have been removed, there are several options for repairing your resulting wound. These will be discussed with you in more detail before your surgery. Your wound may be:

1. closed by the team who performed the micrographic surgery immediately after the tumour has been removed;
2. dressed and then repaired by a plastic surgeon at a hospital chosen by our surgeon;
3. left to heal normally

What are the risks?

Your doctor will explain the potential risks for this type of surgery with you in more detail, but complications include:

1. Bleeding at the site of the tumour
2. Pain. The local anaesthetic should last until you return home. Aspirin free pain relief (such as paracetamol) should relieve any discomfort. The doctor or nurse caring for you can give you more advice
3. Nerve damage. Although your surgeon will try to avoid this, nerves can occasionally be damaged during surgery, leading to a numb area of skin. This is usually temporary
4. Infection at the wound site. You will be given instructions on how to care for your wound to minimise this risk
5. Scarring. You will have a scar after the surgery. The doctors use closure techniques to minimise the effect of this. Scars will fade over time

What do I need to do after I go home?

Before you leave the clinic, please make sure you have been given information about how to look after your wound at home.

You will probably need to rest after the surgery for about 48 hours. If you work, we recommend that you take at least 2 days off after the surgery. We will give you more advice on the day of your surgery.

Will I have a follow-up appointment?

You will have a follow up appointment with the team that repaired your wound.

If your follow up is with us, we will usually see you one week after your surgery to check that your skin is healing well and to remove any stitches you may have. If there are any changes to this, we will advise you on the day of your surgery.

We usually see you again approximately 3 months after your wound has healed.