Mohs Surgery is a microscopically controlled surgery used to treat common types of skin cancer performed by removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumour is reached (called clear margins).
Mohs surgery is the most advanced technique in removing and treating skin cancer.
This surgery is performed by removing thin layers of cancerous skin progressively and examining each layer until only cancer-free skin tissue is left. Today, Mohs surgery has come to be accepted as the single most effective technique for removing the most common types of skin cancer.
Mohs surgery preserves the greatest amount of healthy tissue while also completely removing cancer cells. Mohs Surgery allows us to verify that all cancer cells have been removed, increasing the outcome of a cure while reducing the need for another surgery or treatment.
Mohs surgery is an excellent treatment for skin cancers that have a risk of reoccurrence, are in more sensitive areas such as the eyes, nose, ears, hands, feet and genitals, or for more aggressive forms of skin cancer.
The Cadogan Clinic offers the UK’s most comprehensive mole check for the diagnosis and treatment of skin cancer and is the only mole check approved by the British Skin Foundation.
The Cadogan Clinic Mole Removal service starts from £599
The 4 Steps of Mohs Surgery
1. Surgical removal of tissue
2. Mapping the piece of tissue and then freezing and cutting it
3. Interpretation of tissue under the microscope slides
4. Reconstruction of the area from where the tissue has been removed
One of the great things about Mohs surgery is that you most likely won’t leave your appointment until all the skin cancer is removed. You will know your results right away, as the doctor will be checking every layer of tissue as they’re removed. This is performed as an outpatient procedure, and you will be able to head home the same day knowing that all cancerous cells have been removed.
As the surgery is a combination of several specialised stages, it requires the skills and expertise of a team of qualified professionals — a dermatologist, a pathologist and a plastic surgeon.
There are many ways that you can reduce your risk of skin cancer.
+ Limit your exposure to UV radiation + Use broad-spectrum sunblock when exposed to the sun. Broad spectrum will help protect against both UVA and UVB rays + Use a minimum of SPF 30 in your sunblock, ensure the UVA protection is adequate as denoted by UVA and apply thickly and frequently + Avoid the use of sunbeds (Using sunbeds for the first time below the age of 35 increases the risk of developing melanoma by nearly 60% + Perform a monthly skin self-examination looking for ABCDE of moles
ABCDE Checklist for suspicious features:
+ Asymmetry: Moles that are an irregular shape and have two different halves. + Border: Moles with a ragged border. + Colours: Moles that have a mix of two or more colours. + Diameter: Moles that are larger than 6mm (1/4 inch) diameter. + Evolution: A mole which has changed in size or shape over time.
When performing your monthly skin checks ensure you are doing it after a bath or shower, in a well-lit room, with the aid of a full-length mirror looking for any changes in moles thoroughly.
You can also self-assess yourself for risk of melanoma. The Melanoma Risk Factor Assessment checklist can tell you if you would benefit from a mole check by a dermatologist, or from more regular self-examinations.
The Melanoma Risk Factor Assessment:
+ Have you ever been sunburnt badly? + Does your skin burn first and then tan? Do you tan at all? + Do you have any outdoor hobbies? + Have you ever used sunbeds? + Have you ever lived anywhere abroad that was very hot/sunny? + Have you ever had a job where you worked outdoors? + Has anyone in your family ever had melanoma? + Do you wear sunblock when exposed to the sun?
If you notice any changes to a mole or a patch of skin, it is important to seek the advice of your GP or a dermatologist as soon as possible. If your regular GP has any concerns about the changes in your moles, they will refer you to a consultant dermatologist for further examination.
A dermatologist will perform a full skin examination to check all of your moles. If the dermatologist has any concerns about any unusual moles or patches of skin, they will either go on to remove (excise) the mole or take a sample of a suspicious patch of skin (biopsy) to send in for analysis.
It is important to note that not all changes to moles are the results of skin cancer. It is normal for moles to change in size, number or appearance over time, even some disappearing entirely. Hormonal changes, like those that occur with puberty or pregnancy, can also cause moles to increase in number or to become darker.
Also known as Mohs micrographic surgery, this treatment developed by Dr. Frederic Mohs is a highly specialised and precise outpatient treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. Once a tissue layer is removed, it is then examined by a Mohs technician and doctor under a microscope so that the origin of the cancer can be identified and mapped.
If cancer cells are detected, an additional tissue layer is removed only in areas where the cancer is still present, leaving normal skin intact. Once the cancer has been removed, the Mohs surgeon will explain options for repair of the wound, including natural healing (granulation), suturing the wound together by way of a usual side to side closure, or using a skin flap or graft and reconstruction.
Your doctor will advise you that this procedure will take around half a day as it involves removing the entire cancer in one appointment, removing tissue, analysing it until all the cancer has been removed and reconstruction of the area following removal of the cancer which can take up to one or two hours depending on the size and complexity of the area.
The procedure is performed under local anaesthesia and involves four basic steps:
1. Surgical removal of tissue 2. Mapping the piece of tissue and then freezing and cutting it 3. Interpretation of tissue under the microscope slides 4. Reconstruction of the area from where the tissue has been removed.
As the surgery is a combination of several specialised stages, it requires the skills and expertise of a team of qualified professionals — a dermatologist, nursing staff, histotechnicians and sometime plastic or oculoplastic surgeons.
Mohs surgery is highly successful, and results are as high as 99 percent for the removal of a basal cell skin cancer and 95 percent for squamous cell skin cancer and other recurrent cancers.
Mohs Surgery is very accurate. Mohs surgery is incredibly accurate, as a surgeon will be removing the skin layer by layer off the cancer site. The surgeon will then examine each layer under a microscope to determine if any cancer cells remain in the tissue. The process of removal and inspection under the microscope is repeated until all cancer cell tissue has been removed.
Better Long term Cosmetic Results with Mohs Surgery. Through this method, the surgeon can remove the entire cancer tissue without damaging the surrounding healthy skin tissue. This process keeps the scarring minimal and promotes quicker healing. Approximately 80% of patients will only need to have one layer of skin removed to remove the cancerous tissue. As the recurrence rate is lower than any other technique Mohs can overall give the best long term cosmetic result
Mohs surgery also called Mohs micrographic surgery is a specific surgical technique that can be used to remove many common skin cancers such asbasal cell carcinomas (BCC), squamous cell cancers (SCC) and certain melanomas, especially of the face.
Your doctor may have referred you for micrographic surgery at the Cadogan Clinic Skin Tumour Unit for this treatment if:
+ The cancer is in an important cosmetic or functional areas such as the eyelids, nose, ears, lips, genitals and hands. + Your skin cancer was treated in the past and has returned. + The scar tissue exists in the vicinity of the skin cancer. + There have been previous radiotherapy treatment in the area. + The edges of the skin cancer cannot be clearly defined, and the tumour type is shown to be infiltrative. + Your skin cancer is growing rapidly.
The aim of Mohs surgery is to remove all the skin cancer, but preserve normal tissue. It is the most certain way of curing the tumour.
Mohs treatment involves removing one layer of skin at a time. Each layer that is removed is scrutinised under a microscope in order to look for cancer cells. The process continues until cancer cells are no longer found.
The Mohs surgery is carried out by a dermatologist specially trained Mohs surgery. They are a rare breed. He will be able to repair the resulting defect. If the tumour is in a difficult area or large you may require a skin graft or skin flap. The Cadogan Clinic has reconstructive surgeons at hand who may help. The insurance companies need to be fully involved in the decision to add the extra cost of a reconstructive surgeon’s consultation and operation.
We believe that Mohs surgery should only be performed in a specialised unit where the consultation, Mohs surgery, reconstruction and follow-up are done in the same unit with a multidisciplinary team discussing every patient and decision. All the surgery must be performed in a proper operating theatre with appropriate air changes and nursing staff. Most procedures are performed under local anaesthetic, but general anaesthesia should be available.
Mohs surgery will preserve as much healthy skin as possible and once the cancer is removed, your doctor or surgeon will ensure reconstruction to the area leaves as minimal scarring as possible. Any scarring will improve over time but can take around a year to completely heal. Scar injections and other treatments such as laser resurfacing are also available at Cadogan Clinic so we can you an entire portfolio of treatments around your Mohs procedure.
Your doctor or surgeon will advise you on aftercare at consultation and again immediately after your surgery, you will be asked to visit following your reconstruction to ensure your healing is optimum. Your dermatologist plays an important role in helping you to maintain disease-free skin so regular check-ups can be arranged for the future.
Mohs surgery costs can vary depending on the size and complexity of the treatment required – this will usually be established during your initial consultation. Treatment usually starts from £3000, however every case is different and the best way to receive an estimate for your case is to book in a consultation.
Mohs surgery is nearly painless. Aside from the initial injection of anaesthetic to numb the area, patients will feel very little pain either during of after the surgery. Most clients have a pain level of 0 out of 10 after 24 hours, and any minor pain experienced can usually be handled with paracetamol or an over the counter pain medicine.
To enquire about a consultation with a Mohs Surgery specialist, please complete the form below.
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