What is the cure rate?
Using the Mohs surgery technique, the cure rate is greater than 95%, even if other forms of treatment have failed; however, no one can guarantee a cure rate of 100%.
Who performs Mohs surgery?
Many dermatologists throughout Australia have been trained in skin cancer surgery. When patients require more extensive surgery, however, they are referred to a qualified Mohs surgeon. The period of training to be a qualified Mohs surgeon is a one-year fellowship, during which the dermatologist acquires extensive experience with all aspects of the technique.
Mohs surgery at The Skin Hospital involves a team of people. Your Mohs surgeon is the head of that team but will be supported by a group of highly skilled and specially trained doctors, nurses and technicians.
The doctors working with your Mohs surgeon may include a registrar (trainee dermatologist) and a Mohs surgery fellow. The Skin Hospital is an internationally recognized Mohs surgery unit performing over 1500 Mohs surgery cases per year. We often have visiting dermatologists from around the world observing the surgery. Westmead day surgery provides the only training centre for Mohs surgery in NSW. The training takes one year and is recognised by the Australasian College of Dermatologists.
The Mohs team cares about you and wants to help in relieving any anxiety or fear you may have by making your surgery day as comfortable and relaxed as possible.
How is the surgery performed?
The suspicious skin lesion is treated with a local anaesthetic so there is no feeling of pain in the area. A thin piece of tissue is removed and carefully divided into pieces that will fit on a microscope slide.
The edges are then marked with specially coloured dyes, a map of the tissue which has been removed is made and the tissue is frozen by a pathology technician. Thin slices can then be made from the frozen tissue and examined under the microscope by the dermatologist.
A pressure dressing is applied to the surgical site and the patient is asked to wait in a recovery area while the tissue is being processed.
The doctor will examine the slides under the microscope and be able to tell if any tumour is present. If cancer cells remain, the patient is taken back to the procedure room where another layer of tissue is removed. The procedure is repeated as often as necessary until no cancer cells remain. This process preserves as much healthy skin as possible. After the first layer is taken, a long-acting anaesthetic is used to keep the area numb for many hours.
How long will the surgery take?
The removal of each layer of tissue takes approximately 1–2 hours. Only 20-30 minutes of that time is spent in the actual surgical procedure; the remaining time is needed for slide preparation and for the doctor to read the slides. On average, the surgery usually requires removal of 2–3 layers of tissue (called stages). The whole process including sewing up the wound, usually takes 4-6 hours. Some difficult or larger cases may take longer.
What happens after the tumour has been removed?
After Mohs surgery you will be left with a surgical wound. This wound may be repaired in one of the following ways:
- closing the wound, or part of the wound, with stitches
- various skin closures, such as grafts and flaps, or reconstructive procedures
- healing by spontaneous granulation
- referral for reconstruction to a plastic or oculoplastic surgeon