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Mohs Micrographic Surgery:  Spacer  
Mohs
  • Complete tumour removal
  • Proven 99% cure rate
  • Optimal cosmetic result
 
 

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FAQ about Mohs Micrographic Surgery Spacer   Spacer

What is Mohs Surgery?

Surgery dayMohs Micrographic Surgery is the most advanced and effective treatment for skin cancer available. Mohs Micrographic Surgery has a proven cure rate of 99%, which is far superior to other forms of skin cancer treatment.

Mohs surgery is a highly specialised procedure which ensures complete tumour removal and maximises tissue conservation, thereby minimising scarring and ensuring the optimal post surgical cosmetic result. Mohs surgery is the treatment of choice for tumours on the face and other sensitive areas, especially cosmetic and functionally important anatomic sites.

Furthermore, it is the treatment of choice for ‘high risk’ tumours, such as those which have failed prior treatment, or demonstrate aggressive histopathological features under the microscope. In this group of cancers, traditional surgical cure rates may fall to 60% compared to 92% with Mohs surgery.

Mohs surgery is performed by highly trained specialist surgeons who have completed training as both specialist dermatologists with the Australasian College of Dermatologists and as Mohs surgeons following super-specialist advanced fellowship training with the American College of Mohs Surgery (ACMS). A Mohs Surgeon is specially trained in surgery, pathology and optimal functional and cosmetic reconstruction. A list of ACMS Mohs surgeons can be found at www.mohscollege.org.

Initially developed by Dr. Frederic E. Mohs, Mohs Micrographic Surgery is a state-of-the-art treatment that has been continuously refined over 70 years.

Your specialist will precisely analyse and detect all tumour extensions employing a specialised microscopic technique, allowing your specialist to in effect ‘see beyond the visible disease’. Tumour extensions are exactly mapped out and removed layer-by-layer, down to the roots, until complete tumour eradication is confirmed under the microscope. The surrounding normal healthy tissue is left intact and unharmed. As the most exact and precise method of tumour removal (99% cure rate), Mohs surgery minimises the potential for scarring or disfigurement.

Unlike other forms of skin cancer surgery, Mohs surgery ensures tumour removal, tumour analysis, and surgical reconstruction at the one treatment session.

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How does Mohs Surgery Work?

A microscope will be used to allow your specialist to ensure complete removal of your skin cancer.

There are 2 great advantages of this technique:

  1. Complete eradication of the skin cancer, ensuring a very high cure rate of greater than 99% for even the most difficult and aggressive forms of skin cancer.
  2. Preservation of as much normal tissue as possible, without compromising the high cure rate.

There are 5 key steps to Mohs Micrographic Surgery:

  1. Removal of the clinically apparent/visible skin cancer.
  2. Precision marking and mapping of the excised tissue layer and preparation for microscopic analysis
  3. Microscope guided detection of all tumour extensions.
  4. Precise removal of any residual tumour – unnecessary tissue sacrifice is carefully avoided.
  5. Expert reconstruction of the microscopically controlled tumour free defect; ensuring an optimal functional and cosmetic outcome.

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Who performs Mohs Surgery?

PerformsBecause it is a highly specialized and technically challenging process, Mohs Surgery is only performed by dermatologists who have completed an intensive fellowship which is recognised by the Australasian College of Dermatologists.

Other important team members of the Mohs Surgery Unit include specially trained registered nurses, histotechnicians who aid in the processing of tissue for tumour analysis and our administrative support team. Certain cases may also me attended by a surgical assistant.

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What are the Advantages of Mohs Surgery?

Though most of a skin cancer is usually visible to the naked eye, microscopic “roots” or “branches” may extend outside of the central tumour.  If these extensions are not removed, the skin cancer may reappear.  To guarantee removal of these microscopic areas, most physicians must remove a wide area of normal skin around the visible skin cancer.  Even with this safety margin, however, skin cancers removed with traditional treatments frequently return or require additional surgical procedures.

 In Mohs Surgery, the tumour-removal process is tracked microscopically.  We are therefore able to best ensure that the entire skin cancer is cured while at the same time removing as little normal, healthy skin as possible. This is particularly important in cosmetically important areas.  Of course, any procedure will leave a scar, but by preserving the maximum amount of healthy skin the technique offers the best possible cosmetic result.

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What happens to me on the day of Surgery?

Patients are greeted by the front reception staff who will provide directions to our surgical suite. A member of our nursing team will then ask you some additional questions, take your blood pressure and talk some more about how the day will run.

Once in the procedure room the skin is made completely numb using local anaesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room.  A detailed diagram of the removed specimen is made.

The specimen is colour coded and the technician processes the piece. These are stained and examined under a microscope. This is the most time consuming part of the procedure, often requiring an hour or more to complete.  The doctor then carefully examines the piece under the microscope to visualise the complete edge of the specimen. All microscopic roots of the cancer can thus be precisely identified and pinpointed.

If more cancer is found on the microscopic slides, additional layers are taken only where cancer remains present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no “guesswork” is involved determining where the tumour edges are. Only skin around the “roots” and extensions of cancer is removed.

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How long will my surgery day last?

Treatment RoomThe length of Mohs surgery is unpredictable because some skin cancers grow underneath the skin more than at the surface. There are multiple brief episodes of surgery followed by waiting periods whilst the tissue is processed and evaluated under the microscope. Usually the day lasts 2-4 hours, but rarely can last longer. We therefore ask that you reserve the entire day for surgery, in case additional surgical sessions are required. We suggest you bring material to help you pass the time.

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Should I stop taking my normal medications?

No. Continue all medications unless advised otherwise. Please bring with you a complete list of your medications on the day of your surgery.

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Should I stop over the counter medicines, vitamins, or herbal supplements which have NOT been ordered by my doctor?

Yes. To prevent bleeding problems, please discontinue the following medications and supplements unless ordered by your doctor, starting 7-10 days prior to surgery: Nurofen, aspirin, vitamin E, fish oil, gingko biloba.

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Is there anything else I should do to prepare for my surgery?

Surgery PreparationEat a light breakfast or lunch before your surgery. Arrange for someone to drive you home from surgery in case your postoperative bandage covers your eyes or if sedative medications are required.

 

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Will I be hospitalised?

No. Mohs surgery is performed in a day surgical suite and you will return home the same day.  Hospital facilities are available if necessary. 

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How should I take care of the wound after surgery?

Our staff will demonstrate how to care for your wound and will give you written instructions and your surgeon’s direct contact information in the rare case of an emergency. Usually you will return to have your sutures removed in 1 week.

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When can I resume normal activities after surgery?

We recommend that you avoid strenuous activities for at least a week after your surgery.

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Will I need to come back?

Come BackUsually at least one return visit is needed to examine the healed surgical site or to remove stitches.  For certain types of reconstruction you may be asked to follow up in six weeks or even three months to make sure this has healed to your satisfaction. Afterwards you may return to your referring doctor for routine checkups. A follow up period of five years for the treated cancer is recommended. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring doctor at least once each year, not only to examine the treated skin cancer, but also to check for new skin cancers. 

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Will I have pain, bruising or swelling after my surgery?

Most patients do not complain of significant pain. If there is discomfort, Paracetamol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed. You may have some bruising and swelling around the wound, especially if surgery is being done close to the eyes.

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Will the surgery leave a scar?

All skin cancer treatments will leave some sort of a scar.  However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized.  Immediately after the cancer is removed, we may choose to leave the wound to heal itself, to repair the wound with stitches, or to reconstruct the wound with a skin graft or flap. This decision will be discussed with you prior and is chosen so as to provide the best cosmetic result. The appearance of the site where surgery was performed will continue to improve for up to 12 months.

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Will my insurance cover the cost?

Most Hospital Private Health Insurance policies cover the costs of Mohs surgery and the surgical reconstruction of the wound. Insurance excesses may apply. Please check with your insurance provider for exact information relating to your surgery.

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What if I am not happy with the results?

If your surgery occurred on a highly visible area, it is natural to be concerned about possible postoperative scarring. You will be advised on the likely outcome of expected surgery but no guarantees can be made due to the many factors at play. As the skin heals, scars generally fade to a level where they are quite inconspicuous.  If the scar does not fade, there are many techniques to improve surgical scars, including injections, dermabrasion (a sanding down of the tissue), lasers, and scar revision surgery. Usually these are not undertaken for at least several weeks after the first surgery because the skin will continue to heal, and it may be possible to avoid a reconstructive procedure all together if you give it time.

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