Mohs surgery is a specialised technique to remove skin cancer.
It was invented by Dr Frederic Mohs in the United States.
It involves excising or removing a skin cancer with a certain margin although that extra
bit of skin or margin is less that it would be with non-Mohs standard surgery to begin
with.
Following the removal, the tissue is processed into slides which the Mohs surgeon will
analyze and by mapping what was removed to the patient’s skin, he or she can decide
where any tumour may be left, if at all, and precisely go back to that area and remove more tumour until it’s
all clear.
This allows the tumour to be completely removed at a cellular level to achieve the highest
likelihood of cure.
Mohs surgery tends to be used for higher risk types of skin cancer.
These are skin cancers which may be in difficult areas such as the eyes, nose, lips, ears or
other parts of the face and particularly where we need to try and preserve as much skin as
possible.
There are also more aggressive types of skin cancer which on pathology, show that there
may be roots under the skin, which we cannot see simply by looking at the surface.
By using the microscopic control, this allows us to accurately map out and remove all the
tumour cells.
Mohs surgery is highly effective and considered the gold standard for many higher risk skin cancers.
For skin cancers which are primary or previously untreated, this often has a 99% success rate.
For those skin cancers which have been treated by other methods but then came back or recurred,
this may drop slightly.
It’s not just the cure rate - by sometimes taking less skin, we can create smaller wounds
in the patient and potentially create more minimal scarring.
There are multiple advantages when it is used appropriately.
By cutting the skin, invariably, some form of scar will result and this is true of any
type of surgery.
The question really is how good the scar can be once it’s fully healed.
By potentially minimising the amount of skin removed, this will help create less of a scar
potentially.
However, it’s not necessarily the removal of the skin cancer by Mohs surgery which causes
or creates scarring, but it’s the reconstructional closure of the wound once the tumour is removed.
There are different methods by which this can be done, sometimes when the wound is very
small or superficial.
It can in fact be left to heal by itself in over a period of often a few weeks.
This heals beautifully to leave very subtle marks.
Closing a wound with stitches either side to side.
Techniques such as flaps where cuts are made in different directions to pull skin in.
Skin graft where a skin is taken from somewhere else to then be sewed on to the defect to
effectively resurface it.
All options and depending on how well it’s performed will determine the degree of scarring
but other factors such as how well somebody heals and on occasion, we have unexpected
complications such as an infection which can all impact on the final degree of scarring.
The recovery following surgery will very much depend on what was performed during the Mohs
surgery and the reconstruction following tumour removal.
Some tumours are removed quickly in one stage for example, whereas others may require multiple
stages and this will determine how big the final defect may be.
This will then determine what type of reconstruction is required and a more complicated or extensive
reconstruction will inevitably involve more recovery.
Often, a bandage is applied for two days after which it can be removed.
Anti-scar gels which are often silicon based can be used for several months to optimise
the scarring.
Ultimately, the recovery will depend on the extent of surgery and the type of reconstruction
which was performed.