Mohs Surgery

Mohs Surgery | Manchester Dermatologist

Mohs Surgery, or Mohs Micrographic Surgery is a specialisedst form of treatment for certain types of skin cancer such as basal cell carcinoma (BCCs) and Squamous Cell Carcinomas (SCCs).

Mohs Surgery | Skin Cancer

Basal Cell Carcinomas (BCCs) and Squamous Cell Carcinomas (SCCs) are the two most common types of skin cancer. However, they are also easier to treat and are known as non-melanoma skin cancers. Basal Cell Carcinomas are also referred to as a rodent ulcer.

The third type of skin cancer is melanomas, these are also called malignant melanoma and are less common, however melanoma is the most dangerous of the skin cancers. 


How is Mohs Surgery different form other surgeries?

Unlike many other skin cancer removal procedures, this type of surgery is different from other forms of surgery in that it allows the immediate and complete microscope examination of the specimen. 

It is not possible for a surgeon to see the roots of a skin cancer under the skin surface without a microscope. Mohs surgery gives the best chance of cure for non-melanoma skin cancers compared to all other treatments- even if the skin cancer has grown back following previous treatment. Mohs surgery is also very valuable for preserving normal skin around important sites such as the nose, lips, eyes or ears and keeping the wound as small as possible.

Mohs Surgery Procedure 

Mohs Surgery is only performed by specialist dermatologists who have undergone fellowship training in Mohs micrographic surgery. 

Firstly, the skin around the treatment site is made numb by using a local anaesthetic injection. 

Next, the visible cancer is removed and the  specimen is examined under a microscope after it is processed in the Mohs laboratory. This allows the Mohs surgeon to see if there is any cancerous or abnormal cells left. This takes around 45-60 minutes and during this time, you will be asked to sit in the recovery area

Following this, a diagram (a “Mohs map”) of the removed specimen is then drawn. This microscope check will show if the cancer has been completely removed or if there’s any remaining. 

If there is any cancer remaining, it is carefully marked on the Mohs map and informs the surgeon precisely where he/she needs to go back to take further specimens.

If further tissue is to be removed, you will be asked to come back into the theatre for this once more. This cycle is then repeated until the cancer has been fully removed.

How long does the full procedure take?

As the specimens need to be checked in between removal, Mohs Surgery can take several hours and we ask the patients to stay in the clinic for the entire day (10-4).


Is there a chance Mohs surgery won’t work and the cancer might come back?

 No treatment for skin cancer is 100% effective. Skin cancers can grow back after any type of treatment, but the risk is much lower following Mohs surgery. Mohs surgery offers the best cure rate for basal cell cancer compared with all other skin cancer treatments. The risk of a BCC returning after Mohs surgery is around 1-2% (1 or 2 in 100 patients) for a basal cell carcinoma that has never had treatment before. And around 6-8% (6 to 8 in 100 patients) for basal cell carcinomas that have grown back after treatment for example with standard surgery or radiotherapy.

Are there any alternatives to Mohs surgery?

There are 2 main alternatives to Mohs surgery: Radiotherapy (x-ray treatment) and removal of the skin cancer in the standard way without guidance of the microscope checks.

During your consultation, we will discuss the different treatment options with you. Not all treatment choices may be suitable or possible for your particular skin cancer. However, many skin cancer treatments do not generally offer as high a cure rate as Mohs surgery.

Do I require wound reconstruction after Mohs surgery?

Mohs surgery results in a surgical wound the size of which reflects the true size of the skin cancer. Mohs surgeons have extensive training in wound reconstruction and and in most cases the Mohs surgeon will perform the wound repair. 

There are generally 3 ways to repair a wound:

  1. Closing the wound directly with stitches - the most common procedure.
  2. Using a skin graft or skin flap to repair the wound.
  3. Allowing the wound to heal naturally without additional surgery. This is normally only possible in certain sites.

In some cases, the  wound repair may be done by eye surgeons, ENT surgeons or plastic surgeons, this would require a transfer to a different hospital. If this applies to you, we will discuss this with you in clinic in advance. Unless you are being transferred to another hospital you will normally be able to go home the same day. 

You will have a dressing over your wound that will stay in place for 2 – 7 days depending on the repair and may be quite large and bulky.

Most patients return to clinic to have their sutures removed one week later. Most patients feel quite well after 48 hours. Although, depending on how you feel, you may not wish to return to work for 1 week.

 Each case will be different and we will advise you when you can return to work.

What if I think there is something wrong when I get home?

 We have a telephone helpline service 01615091294. Out of hours please use the emergency GP services, minor injury unit or accident and emergency department.

Is there anything I can do to help myself?

 If you smoke you should avoid smoking for at least 3-4 days before and after surgery as smoking slows down the wound healing process. Similarly, try and avoid alcohol for 3 – 4 days before and after surgery as this can make your wound bleed more.

What happens after I have gone home?

 Although we perform this treatment under local anaesthetic, you may feel quite tired afterwards. Following treatment, you should plan a more restful 2 days or so after surgery.

Interested in Mohs Surgery?

If you're interested in Mohs Surgery for your Skin Cancer treatment, or are worried about the appearance of any moles / lesions. Please contact us today.

Dr Vishal Madan. Dermatology. UK Dermatologist