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Mohs’ Micrographic Surgery
Your Operation Explained
Patient Information
Introduction
This booklet is designed to give you information about having Mohs’
Micrographic surgery and the care you will receive before, during and
after your operation. We hope it will answer some of the questions that
you or those who care for you may have at this time. It does not replace
the discussion between you and your surgeon but helps you to
understand more about what is discussed.
What is Mohs’ micrographic surgery?
Mohs’ micrographic surgery (called Mohs’ for short) is an operation for
certain types of skin cancer. In Mohs’ surgery, the skin cancer is
removed a layer at a time until all the cancer cells are gone.
The process involves:
• A doctor removes a thin layer of skin where the cancer is. The layer
removed is processed, which can take about two hours, and this is
then looked at under a microscope.
• If examination under the microscope shows that some cancer might
still be present it is possible to determine precisely where it is. More
tissue is then removed from only the area involved and examined.
The process continues until there are no signs of any cancer cells left.
The surgery itself may only take a short time; however, the process of
looking at the tissue can take several hours. Each procedure where
tissue is removed and examined is referred to as a stage.
When is Mohs’ surgery used?
The majority of skin cancers will be removed in an operation without
using this technique. Mohs’ surgery is particularly useful for:
• Skin cancers of the face and sensitive areas such as the eye where it
is important to preserve as much normal tissue as possible.
• A cancer where it is difficult to see the extent with the naked eye.
• Cancers that have come back in the same place following previous
treatment.
• Cancers which the doctor thinks have begun to spread into the
surrounding area.
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What are the alternatives?
Other treatments for skin cancer include:
• Surgery by ordinary removal.
• Radiotherapy - directing a beam of radiation at the cancer to
destroy it.
• Chemotherapy (anti-cancer drugs) applied to the skin
• Cryotherapy - freezing the cancer to destroy it.
• Curettage and cautery – first the cancer is scraped away
(curettage) and then the skin’s surface is sealed (cautery).
• Laser surgery (intense beams of light that cut away tissue).
• Photodynamic therapy – applying a special cream to the cancer
under a dressing for four to six hours, which then destroys the
cancer when a special light is shone onto it.
These treatment options will already have been considered in your case
before deciding on Mohs’ surgery. Your doctor can talk to you about
these options.
If the cancer is left it is likely to get bigger and may become more of a
problem. Treatment is, therefore, usually advisable.
What are the benefits of this procedure?
The operation is to remove the cancer. Mohs’ surgery removes less
healthy skin and tissue while making sure that the cancer has all been
taken away. It has an extremely high cure rate (over 95%).
What are the risks of this procedure?
There are no complications specific to this procedure. Complications of
any skin surgery include minor discomfort, wound infection, bleeding, a
scar, numbness in the surrounding skin and nerve damage. If there is a
high risk of any of these complications, this will be discussed with you
before the surgery.
The vast majority of patients have this procedure without any problems.
Before surgery
Please tell us of any medications you are taking and of any illnesses in
the past. In particular if you are taking any tablets which thin the blood
(aspirin or warfarin), as the wound is more likely to bleed.
It is also important that we know if you are allergic to any medication or
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sticking plaster.
The day of surgery
It is essential that you allow at least the whole day for the procedure.
The length of time you can expect to stay in the department will depend
on the number of stages required. Most patients need to have at least
two stages. In between stages you will be made comfortable in a
waiting area in the department, please bring a dressing gown with you.
As it takes time to complete each stage, a book, magazine or something
to occupy you may be helpful to pass the time. If possible bring a friend
or member of your family to keep you company. Refreshments and a
light meal will be provided for you.
The procedure
The operation will take place in an operating theatre and you will be
asked to undress and given a hospital gown to wear. You will be
accompanied into theatre and made comfortable.
The lesion and surrounding skin will be made numb with injections of
local anaesthetic and you should not feel any pain once this is done.
Once the doctor is happy that the area is numb the operation will begin.
A temporary dressing will be applied to your wound while the removed
tissue is prepared and examined. If you require further stages more
local anaesthetic injections will be given, as necessary, before repeating
the procedure.
There will be a wound following completion of the Mohs’ surgery. The
way it is closed will depend on the site and size of the wound. In some
cases, it is best to leave the wound to heal by itself but the majority will
need some stitches, a skin flap or skin graft. It is possible to give some
indication before the surgery as to what is likely to be required but the
final decision can only be made once the cancer is completely removed.
In some cases it is possible to complete the surgery the same day but
this is not always possible. However if a wound requires highly
specialised closure, it may be necessary to coordinate your care with
another surgeon, such as a plastic surgeon, who will close the wound. If
this is the case, the wound may not be closed straight away and
sometimes there may be a few days delay between your Mohs’
operation and closure of the wound. You will be informed if this is likely
to be the case and during this time a dressing will be applied to your
wound and you will be given instructions on its care.
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When will I be able to go home?
Normally you should be able to go home soon after the operation is
completed. If the wound is on your face, you may find that certain types
of dressings can cover your eye or impair your vision. For your safety
and that of others please arrange for a friend or relative to take you
home after your operation. We advise all patients, following Mohs’
surgery, not to travel home alone. If you are planning to travel home by
car, someone else should drive. If you have difficulty arranging
transport, please inform the dermatology department before the date of
your surgery.
What should I do when I get home?
When you get home you should rest quietly for the first 12 hours
following a small operation or for two to three days following a larger
operation. You will be given advice before you leave. You should not
drive for at least 24 hours following the anaesthetic, and it may take
longer before you feel safe to drive.
After surgery
Will I experience pain when the local anaesthetic wears off?
The anaesthetic may last for two to three hours and will then start to
wear off. There may be some mild pain once this happens, but simple
pain killers such as paracetamol should be sufficient. Do not take
aspirin unless it is prescribed by your doctor for another condition. The
pain should not last more than one to two days. If you experience more
severe pain or it lasts more than two days, you should contact either
your GP or the dermatology department for advice.
What should I do if the wound bleeds?
A small number of patients will experience some bleeding after their
operation. It can usually be controlled by the use of pressure. You
should take a gauze pad, paper towel or clean towel and apply constant
pressure over the bleeding point for 15 minutes; do not lift up or relieve
the pressure at all during that period of time. If bleeding persists repeat
the pressure for another 15 minutes. If there is severe or persistent
bleeding, please contact the dermatology department or attend your
local Accident and Emergency department.
What should I do if the wound becomes infected?
A small red area may develop around your wound. This is normal and
does not necessarily indicate infection. However, if the redness does
not subside in two days or the wound becomes more painful or drains
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pus, please contact your GP or the dermatology department.
What should I do if the wound swells?
Swelling and bruising are very common following Mohs’ surgery,
particularly when performed around the eyes. This usually subsides
within four to five days after surgery.
What should I do if the area remains numb?
At times, the area surrounding your operation site will be numb to the
touch as the nerves in the skin have to be cut during surgery. This area
of numbness may persist for several months and, rarely, may be
permanent. Damage to nerves that affect the muscles is very rare
except for deep tumours.
Will I have a scar?
Although every effort will be made to offer the best possible cosmetic
result, skin surgery will leave a scar. The scar can be minimized by the
proper care of your wound. We will discuss wound care in detail with
you and give you information sheets that will outline how to take care of
your wound.
If you have any questions at all, please ask your doctor or specialist.
It is important that you make a list of all medicines you are taking
and bring it with you to all your follow-up clinic appointments. If
you have any questions at all, please ask your surgeon, or
specialist nurse. It may help to write down questions as you think
of them so that you have them ready. It may also help to bring
someone with you when you attend your outpatients’
appointments.
For details of local cancer support groups and organisations, please ask
your Medical Team.
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Local sources of further information
You can visit any of the health/cancer information centres listed below:
Heart of England NHS Foundation Trust
Health Information Centre
Birmingham Heartlands Hospital
Bordesley Green
Birmingham B9 5SS
Telephone: 0121 424 2280
Cancer Information and Support Centre
Good Hope Hospital
Rectory Road
Sutton Coldfield B75 7RR
Telephone: 0121 424 9486
Sandwell and West Birmingham Hospitals NHS Trust
The Courtyard Centre
Sandwell General Hospital (Main Reception)
Lyndon
West Bromwich B71 4HJ
Telephone: 0121 507 3792
Fax: 0121 507 3816
University Hospital Birmingham NHS Foundation Trust
The Patrick Room
Cancer Centre
Queen Elizabeth Hospital
Edgbaston
Birmingham B15 2TH
Telephone: 0121 697 8417
Walsall Primary Care Trust
Cancer Information & Support Services
Challenge Building
Hatherton Street
Walsall WS1 1YB
Freephone: 0800 783 9050
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About this information
This guide is provided for general information only and is not a substitute
for professional medical advice. Every effort is taken to ensure that this
information is accurate and consistent with current knowledge and
practice at the time of publication. We are constantly striving to improve
the quality of our information. If you have a suggestion about how this
information can be improved, please contact us via our website:
http://www.birminghamcancer.nhs.uk.
This information was produced by Pan Birmingham Cancer Network and
was written by Consultant Surgeons, Clinical Nurse Specialists, Allied
Health Professionals, Patients and Carers from the following Trusts:
Heart of England NHS Foundation Trust
Sandwell and West Birmingham NHS Trust
University Hospital Birmingham Foundation Trust
Walsall Hospital NHS Trust
We acknowledge the support of Macmillan in producing this information.
© Pan Birmingham Cancer Network 2010
Publication Date: April 2010
Review Date: April 2013
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