Mohs micrographic surgery

What is Mohs micrographic surgery?

Mohs micrographic surgery (MMS) is a technique used for tumours in high-risk areas (e.g. close to the eyelid, involving the nose) and/or tumours that might have more aggressive features. The technique involves examining the specimen in “real time” whereby multiple rounds of surgical excision are employed, interspersed with examination of each specimen under the microscope. This ensures that the resulting defect is kept as small as possible and that more of the margin is examined than in conventional surgery, improving cure rates.

I work closely with a number of colleagues who perform this surgery and provide a reconstructive service for them, repairing the defects created once the margin is clear. I have recently been invited to co-author a chapter on MMS for a leading surgical reference textbook which has been published and is a core text for many trainees and established specialists. As a TIG Fellowship-trained clinician, I can identify who can benefit from this technique and make the necessary arrangements to work in conjunction with Mohs ablative surgeons to ensure that patients have access to MMS when required.

The images below demonstrate the steps involved in the ablative process of MMS.

How will my Mohs surgery be planned?

If I feel that you will benefit from Mohs surgery, I will discuss your case on the multi-disciplinary team (MDT) meeting that happens weekly and includes colleagues able to provide Mohs ablative surgery. You will meet with your dermatology surgeon to discuss the ablative portion of the surgery, and I will run through all the reconstructive possibilities at a separate consultation. Because the size of the defect can be unpredictable, we will discuss various plans and options that might be required in reconstruction, so that you feel informed, prepared and have plenty of time to ask questions beforehand.

The Mohs surgery will take place under local anaesthesia (awake) at either Solihull Hospital or The Westbourne Centre, and may take one cycle or more, with a variable amount of time spent in surgery that is inherently unpredictable. The Mohs surgeons that I work with are leaders in their field and have significant expertise and experience, ensuring that you will feel comfortable and in control throughout. Wherever possible, I will carry out the reconstruction immediately afterwards at the same sitting.

If I feel that the defect may be more complex to reconstruct, then I will plan for the repair to take place under general anaesthesia (asleep) within a few days of your Mohs ablative surgery. This will also mean that we can discuss the final reconstructive choice during this brief intervening period and answer any remaining questions. You will have secure dressings in place between these appointments and reconstructive surgery will happen at either Spire Parkway Hospital in Solihull, The Priory Hospital in Edgbaston or The Harborne Hospital, part of HCA Healthcare UK.