Mohs Micrographic Surgery
What is Mohs micrographic surgery?
Mohs micrographic surgery, often referred to as just Mohs surgery, is a highly specialised surgical technique for removing certain types of skin cancer. It was pioneered by Dr Frederic Mohs, a general surgeon from Wisconsin in the United States in the 1930s. Dr Hussain is internationally regarded as an expert in Mohs surgery and is considered by many doctors and patients alike as the UK’s leading Mohs surgeon.
Standard operations for treating skin cancer usually involve removing the cancer with an area of healthy normal skin to try to ensure that the entire cancer has been fully removed. If the cancer has not been fully removed, a further, possibly more complex procedure may be necessary.
Mohs micrographic surgery is considered the ‘gold-standard’ treatment for certain types of skin cancer. In order to ensure all the ‘roots’ of the cancer are removed, Dr Hussain will remove the visible part of the cancer a thin layer at a time with a very small margin of healthy skin around it. Each layer is then checked under the microscope by Dr Hussain while you wait in comfortable surroundings.
The layer of skin is examined in horizontal sections, which is a very accurate way of telling if the tumour has been fully cut out as 100% of what is removed is assessed by Dr Hussain. A further layer is taken from any areas in which the tumour remains, if necessary, until all of the skin cancer has been fully removed. This allows for removal of as little healthy skin as possible, which keeps the wound as small as possible. This precise surgical technique ensures that the skin cancer is fully removed on the day of the procedure.
Who performs Mohs micrographic surgery?
Dermatologists with advanced surgical training perform Mohs micrographic surgery. Dr Hussain is one of the UK’s most experienced Dermatological surgeons having undergone vigorous International Fellowship surgical training in Mohs micrographic surgery, dermatopathology and surgical reconstruction. As one of only a handful of dermatological surgeons in Europe who is a Fellow of the American College of Mohs Surgery (www.mohscollege.org) , Dr Hussain’s Mohs surgery credentials are of the highest order. Unfortunately there are certain doctors who claim to perform Mohs surgery, without formal Fellowship training – you should not be afraid of asking your doctor about their training and experience of Mohs micrographic surgery.
What does Mohs micrographic surgery involve?
Dr Hussain & his excellent nursing team will welcome you on the day of your surgery. After going through the consent procedure and answering any questions you may have, Dr Hussain will mark out visible part of the skin cancer and then proceed to numb the skin with a local anaesthetic injection; you will be fully awake during the procedure, but don’t worry you will be completely pain free. The tumour is then removed with a very small margin of healthy skin.
Dr Hussain will then create an accurate map of the surgical site and the sections of removed tissue, to enable him to know exactly how the removed skin tissue corresponds to the wound so that the correct place for any further surgery can be identified very precisely. A pressure dressing is applied to the wound and you will then wait whilst the removed skin tissue is examined. This may take anywhere from 45mins to 2 hours.
Whilst you are waiting, once Dr Hussain’s laboratory team have prepared the slides for him to assess, the removed skin tissue will then be examined under a microscope by Dr Hussain to determine whether any of ‘roots’ the tumour remain. If any ‘roots’ of the tumour are seen, you will be given further local anaesthetic and a further layer will then be precisely removed by Dr Hussain in process which is very similar to the first stage of surgery.
The process is repeated as many times as necessary until there is no further tumour remaining. It is important to realise that what is present on the skin surface, often just represents the ‘tip of the iceberg’ and so the tumour can be much larger than is visible at first.
Dr Hussain often explains that after Mohs micrographic surgery, the hole that is created, is the smallest hole that was needed to get rid of the skin cancer.
What happens when the entire tumour has been removed?
Once the skin cancer has been fully removed, Dr Hussain will reconstruct (repair) the wound on the same day.
Dr Hussain has an international reputation of excellence when it comes to providing patients with the best cosmetic results after Mohs micrographic surgery. He will endeavour to repair your wound in the best way possible after a full discussion with you about what is involved (see Gallery).
There are always several methods of repairing a wound and Dr Hussain will take you through the options available to you in a caring and understanding manner, using language that you will understand. Dr Hussain is passionate about providing all his patients with the best long-term outcomes but also realises that each patient is a unique individual with differing expectations and demands. Dr Hussain believes firmly that this aspect of surgery is anything but a ‘one size fits all’ approach and will tailor the reconstruction to your individual expectations.
Which conditions can be treated with Mohs micrographic surgery?
Dr Hussain utilises Mohs micrographic surgery when treating types of common skin cancers known as a basal cell carcinomas (BCC) and squamous cell carcinomas (SCC). These skin cancers most frequently arise in the head and neck region where minimising surgical wounds is of particular importance in order to ensure the best cosmetic outcome. Mohs micrographic surgery is also used by Dr Hussain for treating other skin cancers including for example: atypical fibroxanthomas (AFX), microcystic adnexal carcinomas (MAC) & desmoplastic trichoepitheliomas (DT).
Who is suitable for Mohs micrographic surgery?
Mohs micrographic surgery is particularly useful in the following circumstances:
- Recurring or previously incompletely removed skin cancers.
- Infiltrative skin cancers (where the edges of the skin cancer can be difficult to see so traditional methods risk incomplete removal).
- Skin cancers in areas where it is cosmetically better to remove as little healthy skin as possible e.g. eyelids, nose, ears, lips.
- Skin cancers arising at the site of previous surgery or radiotherapy.
- Very large tumours (where removing as little healthy skin as possible can help minimise the size of the wound).
How effective is this treatment?
The cure rate for Mohs micrographic surgery is high for both primary (new) tumours (over 99%) and recurrent tumours (up to 95-97%).
What are the complications of this treatment?
All surgical procedures carry some risk. For Mohs micrographic surgery the main risks are listed below, but this is something Dr Hussain will discuss in detail with you prior to your surgery:
Bleeding/bruising. Bleeding will be stopped during the surgery but can restart afterwards. It is normal to have bruising that may persist for a while. If you take a blood thinning medication, such as warfarin or aspirin, or if you have a medical condition that causes you to bleed more easily, this should be discussed with Dr Hussain before the surgery as it may require additional care during the surgery. It is not always necessary to discontinue your medication but Dr Hussain may ask you to have a blood test before the day of your surgery.
Wound infection. There is a very small risk of developing an infection in your wound (approximately 2%). If Dr Hussain feels in your particular case, there is a risk of infection you may be prescribed antibiotics at the time of the surgery.
Numbness/nerve damage. Small nerves may be cut during the surgery to remove the skin cancer. This can result in numbness which improves over weeks or months as the new nerves grow. Every effort is made to avoid this when removing the tumour; however, in some circumstances it may be unavoidable if the tumour ‘roots’ are wrapped around the nerve. Rarely, a nerve that supplies movement to a muscle can be affected resulting in weakness or paralysis of that muscle. Dr Hussain will talk you through such risks in considerable detail during your consultation.
How long will I need to stay in hospital?
Mohs micrographic surgery is a day-case surgical procedure, which means that you will be discharged home on the day of your procedure.
The actual amount of time that you spend in hospital on the day however will depend on how many layers have to be removed before the skin cancer is fully removed. Another point to consider is how large the tumour is and whether it has been treated before, as very large tumours & those which have recurred after previous treatment will take longer to analyse in the laboratory. You should expect to spend all day in the hospital as a general rule.
What should I bring with me on the day of Mohs micrographic surgery?
Dr Hussain and his secretarial team will discuss all the practical aspects of the day when you are booked in for surgery including what to bring, what to wear etc. You are also allowed to bring a partner, friend or relative on the day of surgery to keep you company throughout the procedure.
How should the treated area be cared for when I get home after Mohs micrographic surgery?
Dr Hussain’s secretarial team will provide you with written instructions on how to care for your wound after surgery. Dr Hussain himself will also discuss this in more detail with you on the day of your surgery. Dr Hussain is contactable 24 hours a day for all of his Mohs surgery patients.
Are there alternative treatments to Mohs micrographic surgery?
Yes – there are always alternatives. Dr Hussain is an expert in the treatment of skin cancer and before scheduling you for Mohs micrographic surgery, he will explain in detail if alternative treatment options are available for your type of skin cancer, providing you with as much information as you require to make an informed decision.