Mohs Micrographic skin cancer surgery has the highest success rate of all surgical treatments and aims to conserve as much normal skin as possible. It is a specialised skin cancer removal technique used for removing the nastiest melanomas or when seeking the most cosmetically elegant outcome. Associate Professor Greg Goodman was the first micrographic surgeon in Victoria and has performed Mohs surgery for almost 25 years at the Skin and Cancer Foundation, where he is Chief of Surgery. Working alongside Greg is a dedicated team which includes plastic surgeon Mr Jeremy Richardson who will ensure the neatest and most cosmetically elegant result.
How does the procedure work?
After the results of an initial biopsy are known, the micrographic surgeon begins by making the smallest possible excision to remove the visible skin cancer. The surgeon immediately examines the specially marked and mapped specimen under a microscope to gauge whether the edges of the lesion are clear of skin cancer cells. If not, they will know exactly where from their mapped specimen, and go back to the patient and excise a further layer of tissue and re-examine it. This procedure is repeated until they can no longer detect any cancerous cells under the microscope. This technique allows the surgeon to remove the minimal amount of tissue required for clearance, resulting in a more cosmetically elegant outcome, whilst still ensuring all the cancer cells are removed. Unlike routine pathology that looks at a sample of the specimen, the Mohs method looks at the entire surface of the specimen and therefore is much more exact.
what will the patient experience during the procedure?
A local anaesthetic is injected into the skin before the surgery begins. As it can be time consuming to prepare the slides for the microscope, and the surgeon may have to return to the area several times, the patient may remain in the clinic for much of the day. After clearance, repair is usually possible on the same day and may range from allowing the area to repair itself over time (secondary intention healing), through to simple closure, flap or graft.
what can the patient expect after the procedure?
After the procedure there is no difference to what is expected from any surgical excision. Mild to moderate pain and some bruising may occur. Increasing pain should be reported to exclude infection and postoperative bleeding.