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Mohs micrographic surgery is the most advanced technique for removing and treating non-melanoma skin cancer.
This surgery is performed by removing successive thin layers of cancerous skin and examining each layer under a microscope – right there and then in the theatre - until only cancer-free skin tissue is left.
Today, Mohs surgery has come to be accepted as the most effective technique for removing the most common types of skin cancer.
The benefit of Mohs surgery is that it is able to preserve the greatest amount of healthy tissue around the cancer, while also completely removing all dangerous cancer cells. Mohs Surgery also allows your surgeon to verify that all cancer cells have been removed during the procedure, increasing the likelihood of a full cure and reducing the likelihood of further surgery.
Efficient, cost-effective treatment
Highest Cure Rate
Mohs surgery is therefore 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.
Cadogan Clinic is one of just a handful of specialist skin cancer facilities with the capability to perform Mohs micrographic surgery in London.
We have invited a selection of the country's very best consultants to join us at the Cadogan Clinic so that you can be sure that whatever the nature of your treatment, you will be seeing one of the top practitioners in the country.
Dr. Nisith Sheth
Dermatologist and Dermatological Surgeon / GMC: 6032057
Dr. Sheth is a Consultant Dermatologist and Dermatological Surgeon at the St John’s Institute of Dermatology, one of the world’s leading centres for patients with skin problems, based at Guy’s and St Thomas’ Hospitals. ...See Full Profile
The visible skin cancer is outlined with a marker pen by your surgeon and the area is numbed with local anaesthetic; you will be awake during the procedure.
The cancer is then surgically removed with a very fine margin of healthy skin around and underneath it. A map of the surgical site and the sections of removed tissue is drawn by the surgeon so he can understand exactly how the excised tissue maps to the wound site. If further excision is required, the corresponding area can be easily identified.
The excised tissue is then examined under a microscope to assess whether any skin cancer remains. It can take up to an hour for your technician to assess this, and meanwhile you will be asked to wait with a dressing over the wound site.
If cancerous tissue is observed in the skin examined under the microscope, a further layer will be removed from the corresponding area on the wound.
The surgeon will know exactly where to find the remaining tumour from the map drawn of the location of tumour. It may be necessary to inject more local anaesthetic before further surgery.
This process is repeated as many times as is necessary until there is no cancer remaining. Sometimes the tumour can be much larger than is visible at first on the surface of the skin, so it is only via this iterative process that comprehensive excision can be assured.
That said, approximately 80% of patients will only need to have one layer of skin removed to remove the cancerous tissue.
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.
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To enquire about a consultation with a Mohs Surgery specialist, please complete the form:
Why Do People Have It?
Mohs surgery is considered the very best technique for the safe and effective removal of non-melanoma skin cancer
During Mohs micrographic surgery the skin cancer is removed one thin layer at a time and then immediately assessed under a microscope (either by the surgeon or a pathologist), enabling an exceptionally precise surgical excision of the skin cancer.
This process reduces the margin of healthy skin surrounding the cancerous area that is also removed during surgery, reducing the size of the wound and scar site. Your surgeon can also be certain 100% certain that the skin cancer has been fully removed on the day of the procedure.
By contrast, traditional skin cancer removal techniques involve a less precise approach, often meaning that a more sizeable area of healthy unaffected skin is removed along with the cancerous area. Alternatively, if too little is removed, a second procedure is required. It will also not be until the results from the histopathology have been received, that you will know for certain that your skin cancer has been fully removed.
Mohs surgery is generally regarded as the best technique to remove non-melanoma skin cancer and is generally recommended in all complex or high risk cases.
These may include:
For small or superficial low-risk cancers in areas such as the abdomen, chest, back, arms and legs, standard techniques such as traditional surgical excision, cryotherapy or photodynamic therapy can provide adequate treatment.
For melanoma skin cancers it is important to leave a wide margin around the skin cancer site, so Mohs surgery is not appropriate.
I was deeply impressed with the service and professionalism of Cadogan Clinic. I saw a lovely dermatologist - who really put me at ease and who I will most definitely visit again. Staff were so friendly, reception left no question unanswered. I will definitely be recommending to family and friends
I am very pleased with the extremely efficient help and advice I received from Cadogan Clinic recently when I was worried about a skin problem. I was impressed with how quickly and efficiently my friendly patient advisor was able to reassure me and expedite a consultation. I highly recommend the clinic and the very professional team who work there.
The Cadogan Clinic and my consultants are truly experts in their field, and have looked after all my skincare concerns and needs. I highly recommend then and would never go see anyone else! I cannot recommend them enough.
I had a wonderful experience at the Cadogan Clinic. I immediately felt taken care of by my friendly patient advisor and I was supported the whole way through my course of treatments. My skin is no longer struggling with acne and scarring thanks to mt surgeon. Each time I left the clinic after an appointment my confidence had been boosted and I am doing much much better with myself now.
HOW CAN I REDUCE MY RISK OF SKIN CANCER?
There are many ways that you can reduce your risk of skin cancer.
ABCDE Checklist for suspicious features:
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:
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.
WHY IS IT CALLED ‘MOHS’ SURGERY?
Mohs micrographic surgery is named after the doctor who developed the technique, Dr Frederic Mohs.
HOW MUCH DOES MOHS SURGERY COST?
Mohs surgery costs 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.
WHO PERFORMS MOHS MICROGRAPHIC SURGERY?
Mohs surgery is a combination of several specialised stages, and requires the complementary skills of a team of qualified professionals — a dermatologist, nursing staff, histo-technicians and sometime plastic or oculoplastic surgeons.
Only dermatologists or dermatological surgeons who are specially trained in Mohs micrographic surgery can perform this procedure. This training is additional to that required to become a general dermatologist.
Occasionally, support may be given by other specialists, e.g. a plastic surgeon to reconstruct the wound site, or to provide a skin graft or flap in more complex cases.
Cadogan Clinic is able to provide all of these skillsets to our Mohs patients, and the entire process takes place on-site in our theatres and recovery suite. Your consultation, Mohs surgery, reconstruction and follow-up are all done in the specialist unit courtesy of our multidisciplinary team.
All 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 can be made available.
HOW LONG DOES A MOHS TREATMENT TAKE?
Mohs surgery is a complex process and can take as long as 3 – 4 hours, depending on the complexity of the cancer in question.
Removing the tissue and analysing it – often more than once - can take up to one or two hours, whilst the reconstruction of the site following the removal of the cancer can also take a similar amount of time.
WHAT HAPPENS DURING MOHS SURGERY?
The procedure is performed under local anaesthesia and involves three basic steps:
WHO IS SUITABLE FOR MOHS MICROGRAPHIC SURGERY?
Mohs micrographic surgery is suitable for complex or high risk non-melanoma skin cancer removal.
It is particularly useful for:
HOW LONG WILL I NEED TO STAY IN HOSPITAL?
Mohs surgery is typically complete in a matter of hours, after which you will be discharged home.
You can expect to spend a full morning or afternoon at the Clinic at the very most.
HOW EFFECTIVE IS THIS TREATMENT?
Mohs surgery has the highest cure rate for both new (up to 99%) and recurrent tumours (95%).
Traditional surgical methods have a cure rate of around 90%.
WHAT ARE THE COMPLICATIONS OF THIS TREATMENT?
Whilst the risks of Mohs surgery are minimal, all surgical procedures do carry some risk.
Risks can include:
ARE THERE ALTERNATIVE TREATMENTS?
Yes, traditional surgical skin cancer removal or radiotherapy may be preferred. Your doctor will outline the preferred option at your initial consultation.
IS MOHS SURGERY SUCCESSFUL?
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 – your 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.
Mohs surgery has better long term cosmetic results - 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.
IS MOHS SURGERY PAINFUL?
Mohs surgery is largely pain-free. Aside from the initial injection of anaesthetic to numb the area, patients will feel very little pain either during of after the surgery.
Most patients experience no pain at all during or after the procedure. If minor pain is experienced, this can usually be handled with paracetamol or an over the counter pain medicine.
WILL THERE BE A SCAR AFTER MY MOHS SURGERY?
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 provide you with an entire portfolio of treatments around your Mohs procedure.
WHAT AFTERCARE DO I NEED FOLLOWING MY MOHS SURGERY?
Your doctor or surgeon will advise you on aftercare at your consultation and again immediately after your surgery.
You will be asked to return to the Clinic following your reconstruction to ensure your healing is progressing as planned.
Your dermatologist plays an important role in helping you to maintain cancer - free skin so regular check-ups can be arranged for the future.
The Cadogan Clinic is based at 120 Sloane Street in Chelsea, just off Sloane Square and the Kings Road.
We are accessible by all major bus routes that pass through Sloane Square and Sloane Street, as well as Sloane Square tube station.
We are just a 5 minute walk northwards up Sloane Street once you have arrived at Sloane Square.
Local pay parking is available just around the corner from the Clinic on Cadogan Gate, Cadogan Square and Cadogan Gardens. Our local residential parking zone is the Royal Borough of Kensington & Chelsea.
Address: 120 Sloane Street, Chelsea, London, SW1X 9BW
This month Consultant Dermatologist Dr Susan Mayou discusses rosacea with Heart.co.uk, and talks to the Daily Mail about the latest skincare craze, chlorophyll.