Mohs Micrographic Surgery

What is Mohs Micrographic Surgery?
Mohs surgery is a highly specialised surgical technique to remove certain skin tumours (basal cell carcinomas – also known as BCCs or rodent ulcers, and squamous cell carcinomas – also known as SCCs). It offers the following advantages:

  1. It has a very high cure rate. - No other treatment modality can guarantee complete removal of the tumour to as high a degree of certainty.
  2. This technique ensures that a minimal amount of normal tissue adjacent to the tumour is sacrificed. - This is of immense importance around the eyes. This also ensures that the reconstructive surgery required to deal with the ensuing defect is less extensive.
  3. The technique ensures that a tumour free defect is presented to the reconstructive surgeon who does not underestimate the size of the tumour – see example below. - This much reduces the risk of subsequent recurrence of the tumour.
A morphoeic basal cell carcinoma at the medial canthus
The appearance immediately following a Mohs micrographic excision of the tumour showing that the margins of the tumour were poorly defined by clinical examination alone.
The appearance 3 months following oculoplastic reconstruction using a skin graft from the upper inner arm.
A morphoeic basal cell carcinoma at the medial canthus
The appearance immediately following a Mohs micrographic excision of the tumour showing that the margins of the tumour were poorly defined by clinical examination alone.
The appearance 3 months following oculoplastic reconstruction using a skin graft from the upper inner arm.

Why is it necessary to travel to another hospital in Manchester for this treatment? The Mohs surgeons for this region are Dr. Nick Telfer and Dr. VIndy Ghura, who are Consultant Dermatologists based at the Dermatology Department of the Salford Royal Foundation Hospital Trust in Salford. They are amongst the very few doctors in this country who have received specialist training in Mohs micrographic surgery. Their role in the management of a patient with a BCC or SCC involving the eyelids and/or the surrounding areas of the face is to remove the tumour. Once this has been done the patient then travels across to Manchester Royal Eye Hospital where the defect left by the Mohs surgery is reconstructed. This will normally take place the same day or occasionally the following day under either “twilight anaesthesia” or under general anaesthesia if the defect is particularly large.

What will the Mohs surgeon do?
Dr. Telfer or Dr. Ghura will inform you of when and where your Mohs surgery will take place. This procedure is performed under a local anaesthetic and the removal of the tumour takes place in stages. There is a waiting period between each stage of approximately 1 hour during which time you will be resting in a waiting area, with a temporary bandage in place. Do not eat or drink anything from 8.00 a.m. (at least 6 hours before your planned reconstructive surgery. You may have a drink of water up to 2 hours before the reconstructive surgery but nothing else.

The procedure may take anything from 1 hour to most of the morning to perform, and once the procedure has been completed you will transfer to Manchester Royal Eye Hospital. We would like you to be as comfortable as possible while you are waiting in between stages, so you might like to:

  • a) Bring something to read
  • b) Bring a friend or relative (but not the whole family!)

What will happen when I arrive at Manchester Royal Eye Hospital?
You will be seen by the nursing staff initially. The surgical wound will then be carefully examined by your surgeon or his/her assistant to determine precisely what type of reconstructive surgery will be required. This will be discussed with you. This will be performed in the operating theatre under “twilight anaesthesia” so that you are very relaxed. Very occasionally, if the defect is very large, this surgery will be performed under general anaesthesia instead. This will be discussed with you. Admission to hospital is not usually necessary if local anaesthesia only is required but if admission to hospital is required because you live some distance away, or you live alone, or because you would prefer to, please bring an overnight bag so that you are prepared to stay with us if necessary.

What will happen following the reconstructive surgery?
You will be discharged home within an hour of the completion of the surgery. Pressure dressings over the eye along with a bandage around the head may be kept in place for a few days and arrangements will be made for you to attend your surgeon’s clinic a few days to a week later for the dressings to be removed and sutures to be removed if required. If you have any queries about the reconstructive surgery arrangements call your surgeon’s office.

Mohs surgery defect Appearance immediately following eyelid reconstructive surgery using a local skin-muscle flap Appearance 6 months after surgery
Mohs surgery defect Appearance immediately following eyelid reconstructive surgery using a local skin-muscle flap Appearance 6 months after surgery

Unless you have been told otherwise please do not use aspirin or any aspirin containing medications for at least 3 weeks prior to the surgery. This may include a number of arthritis medications. You should check with your GP first to ensure that it is safe for you to discontinue any aspirin, Warfarin or Clopidogrel.

Please Note: If you are insured it is important that you clarify in advance with your insurance company the level of reimbursement they will allow for this surgery. Unfortunately, some insurance companies grossly under-estimate the expertise and time required for this type of treatment and leave patients with a shortfall. Your surgeon’s secretary/P.A. will be happy to provide your insurance company with details of your proposed treatment along with a quote of the costs.

Consultants who undertake this procedure:

Saj Ataullah
Anne Cook
Brian Leatherbarrow
Ahmed Sadiq