Advanced Treatment For Facial Skin Cancer
This technique is not necessary for most skin cancers but is a powerful tool to enable complete eradication of facial skin cancer where the clinical margins of the cancer are often indistinct.
The power of this procedure to treat skin cancer comes from its ability to remove the guesswork and uncertainty in the treatment of skin cancer. Even those cancers that have been previously treated unsuccessfully by other methods are often curable by Mohs Micrographic Surgery.
Microscopic examination of the cancer tissue in specially designed segments by the operating Dermatologist allows the tracing and entire removal of a skin cancer including its roots with great accuracy. Using the Mohs technique, appropriately trained Dermatologists can see beyond the visible extent of a tumour and precisely identify and remove the entire tumour leaving the healthy tissue unharmed. The Mohs technique ensures the best possible cosmetic result following the removal of the tumour.
This procedure is most commonly used to treat two of the most common types of skin cancer; basal cell and squamous cell carcinoma, but may also be used to treat melanoma and other rarer types of skin cancer. Treatment Available At The Tauranga and Auckland Skin Centre
Dr Neil Mortimer
Dr Paul Salmon
Is Mohs Surgery for Me?
What do I expect from my Mohs Surgery?
Do I need Mohs Surgery?
Not all tumours of the face and neck need to be treated with Mohs, but it is recommended for tumours which have:
- Been previously treated but have recurred or have been incompletely excised
- Tumours with aggressive histological subtypes (sclerosing, infiltrating, morphoeic, micronodular)
- Large tumours (over 2cm in diameter)
- Tumours occurring in embryological cleavage planes of the face such as the creases of the nose and in front of and behind the ear)
- Tumours occurring in areas where tissue conservation is of the utmost importance such as the eyelids, lips, nose and the ears
- High risk or aggressive types of squamous cell carcinoma (size larger than 2.0cm, infiltrative histology, poorly differentiated, Clark's level IV or greater)
It is also recommended for the treatment of small and less aggressive tumours where there are multiple tumours in the same surgical area, or if the patient is of a young age and may be expected to have further skin cancers on the face in the future, or the patient has multiple tumours in the same surgical field or has had multiple tumours in the past and there is a need for stringent tissue conservation.
How is Mohs Carried Out?
If there is no tumour remaining you will be brought back to the theatre suite for delicate plastic surgical reconstruction of your wound. If the slides show residual tumour then you will go back to the operating room where additional tissue will be removed only in the area where the roots are present. The tissue will be examined again while you wait.
The majority of skin cancers are cleared on the first or second visit to the operating suite during the morning. Reconstruction of the wound usually takes place in the late morning or afternoon. Following this you will have a large bulky dressing and you will need to rest completely for at least 48 hours following your surgery, and sometimes longer. Stitches are usually removed between 5 and 10 days post operation. There may be discomfort, bruising or swelling following surgery. These are usually well controlled with the prescription medicines that you will be given following your procedure.
The procedure is more protracted than simple excisional treatment. But it is the precise and fastidious nature of this technique which gives it its power.
Clinical studies have shown that Mohs micrographic surgery has a 10 year cure rate of up to 99% in the treatment of basal cell carcinomas, 97% in the treatment of squamous cell carcinomas.
When Choosing a Surgeon
Two common training programmes are available to obtain a qualification in the Moh's technique; The American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO) and the American Society of Mohs Surgery. The ACMMSCO run one and two year Fellowship Training Programmes. ACMMSCO training programmes involve intensive involvement in at least 500 cases of Mohs micrographic surgery and their associated pathology and reconstructions. This large number of cases during the training period is required to ensure competence in a large number of clinical presentations of different types of skin tumours, competence with examination of the pathology and the development of skills for a wide range of reconstructive options. Almost every single scientific study substantiating the high cure rate for Moh's Micrographic surgery comes from members of the ACMMSCO. Completion of the Fellowship of the American College of Mohs Micrographic Surgery and Cutaneous Oncology is the only accepted qualification for the vast majority of universities in the United States seeking to employ Mohs Micrographic surgeons. The Skin Centre under Dr Salmon's direction is one of only three sites outside the United States of America to offer this rigorous training programme to graduate specialists.
If your surgeon has recommended that you have Mohs micrographic surgery, you should not be afraid to ask what the surgeon's qualifications are. If you require further information I suggest you talk with your dermatologist or visit www.mohscollege.org.