Mohs surgery information

Please watch the educational video, featuring 3D animations, I produced previously (while working in East Kent University Hospitals NHS Foundation Trust - so not all of it is strictly relevant to my private patients):

www.eastkentmohs.co.uk

The contents of my Mohs information leaflet are also below:

MOHS SURGERY

What is Mohs Surgery?

Frederick Mohs was an American surgeon who, during the 1940s, pioneered a new type of surgery to remove non-melanoma skin cancers (NMSCs) such as basal cell carcinomas (BCCs). Mohs surgery is a specialized technique that enables the removal of all the cancer, in several stages, without removing too much healthy tissue. This type of surgery is also called ‘micrographic surgery’, which means that a microscope is used to examine what is being done during the procedure.

It can only be performed at particular locations.

What is special about Mohs surgery?

Some skin cancers are deceptively large - far bigger under the skin than they appear to be on the surface.  These cancers may have "roots" in the skin or along blood vessels, nerves or cartilage.  Also, skin cancers that recur after previous treatments may extend under the scar that has formed.

In Mohs surgery, the tumour and some surrounding skin is removed and examined under the microscope to check that all the cancer has been removed. If the cancer is still present, I know exactly where it is, so more tissue is very carefully removed and the process is repeated until I am confident that all the cancer is gone.

 When is Mohs surgery recommended?

Mohs surgery has the highest reported cure rate of all treatments for NMSCs because it is specifically designed to remove these cancers by tracking and removing the cancerous ‘roots’. This allows for precise and accurate removal of skin cancers with minimal loss of healthy skin. For this reason, Mohs surgery may result in a smaller scar, as compared to other methods of skin cancer treatment.

What Mohs surgery involves for you

You will be called into the operating room where I will remove the tumour and a small amount of surrounding, healthy skin. Mohs surgery is done under local anaesthetic. You will then be asked to return to the waiting area while the sample is analysed – this takes from 30 minutes to 2 hours. This process will be repeated until I am confident the cancer has been completely removed (please bring something to do – it could take all day).

Your wound will be repaired in the way that gives you the optimal cosmetic result and will be discussed with you on the day. You will usually be allowed home the same day.

If you are having a large or complicated tumour removed, I may have to involve other specialists to help repair the wound, and this may involve either a second procedure in the following day or two, or an overnight stay in hospital. You should be advised about this well in advance of your visit, although occasionally this has to be arranged on the day of your surgery.

 What happens afterwards?

You will usually go home with a dressing in place for at least 24 hours. More extensive and/or complicated procedures may require more elaborate dressings to stay in place for a longer period of time. This will be discussed with you on the day of the procedure.

Important Dos and Don’ts for patients

- Abstain from smoking for two weeks before and two weeks after surgery to minimise the chance of poor healing.  Nicotine patches can be obtained from your pharmacy to assist you.

- Avoid anti-inflammatory medications for three days before your surgery to reduce the risk of bleeding - such as ibuprofen, voltarol (diclofenac) or naproxen.

- Avoid herbal remedies which may increase bleeding e.g. Ginger, Gingko, Garlic.

- Do NOT stop Warfarin, Aspirin, Clopidogrel or Rivoroxaban unless your doctor tells you otherwise. If you are on warfarin, please bring a recent (within 3 days) INR result with you, otherwise the procedure will be cancelled.

- Bring a family member or friend (Pandemics permitting): You may have swelling and/or a large dressing obscuring your vision, and many patients may feel shaky after the surgery. It is best NOT to drive yourself home – your insurance company may also not cover you to drive after local anaesthetic.

- Do not wear makeup if you are having surgery on the face.

- Let us know if you have a pacemaker, any allergies (for example latex, medications) or any medical condition requiring antibiotic therapy prior to surgery (e.g. heart valve replacement, recent joint replacement).

What can you expect afterwards?

Possible complications will be discussed on the day of your procedure. Common risks include:

Pain/Discomfort - You may experience some discomfort after your procedure. I suggest you use paracetamol or

co-codamol for managing this.  Avoid medications that thin your blood unless prescribed by your GP.

Bleeding - There is a small risk of bleeding following the procedure. The dressings applied will minimise this.

Restrictions - Depending on the size and location of the wound, I may recommend restricted physical activity for a period of time after the procedure.

Infection - There is a small risk of infection after any surgical procedure. Antibiotics may be prescribed if necessary.

Swelling and Bruising - This is very common following surgery, especially if the procedure is close to the eyes.  This usually subsides within a few days.

Numbness - There is a potential for numbness following the procedure which can last for several months or longer. This can be discussed with your surgeon at any time.

Scarring - Scarring from the procedure usually settles very well. Larger skin cancers and wound repairs can leave more obvious scarring for some time. There are a range of options I can discuss with you to deal with each circumstance.

Follow up - I usually arrange to see you a few months later.

Further information:

Please watch the video I produced at www.eastkentmohs.co.uk

If any of the above information raises questions for you, please contact my secretarial team on 07813964772