What is Mohs Surgery?
Mohs Surgery, or Mohs micrographic surgery, is a highly precise surgical technique used to treat Skin Cancer created by Frederick Mohs in 1938. Mohs Surgery is a technically intensive challenging procedure requiring great experience and training to undertake properly and successfully. Dr Ghura undertook very extensive Fellowship training over 18 months before setting up an award- winning Mohs Unit.
He is a very senior Mohs Surgeon and Dermatologist in Manchester working at one of the country’s largest NHS Mohs centres (Salford Royal Hospital). He has undertaken thousands of Mohs surgery cases over 20 years with excellent results and outcomes and is proud to have been elected President of the British Society for Dermatological Surgery (BSDS) to which almost all Mohs Surgeons in the UK belong to.
How does Mohs Surgery work?
Dr Ghura uses Mohs Surgery to remove the Skin Cancer progressively in stages. He then examines each stage very carefully with a microscope. Mohs surgery allows Dr Ghura to ensure the Skin Cancer is fully removed whilst enabling him to preserve as much normal skin and tissue as possible. Mohs surgery gives Dr Ghura the best cure rates and instant results. Standard surgery takes 2 weeks or more for results to come through and if Skin Cancer is left behind, further operations are needed.
Mohs surgery means Dr Ghura can produce the smallest and least deep wounds and therefore allows him to get the best reconstruction, scar and cosmetic outcomes. Dr Ghura undertakes Mohs surgery in Manchester as a daycase or outpatient procedure under local anaesthetic making it both safe and convenient for the patient. Dr Ghura uses Mohs surgery to treat Basal cell carcinoma and Squamous cell carcinoma which are the most common Skin Cancers. These usually occur on the face and so its most important to ensure their full removal and best cosmetic outcome.
Are there any Risks?
Dr Ghura has undertaken thousands of Mohs Surgery cases over 20 years. He performs the technique under the safety and convenience of local anaesthetic as an outpatient or daycase procedure so there are no serious risks.
As with any surgical procedure, there can be bleeding from the wound after Mohs surgery and so you will leave us with stitches and a padded dressing. There will be some pain and tenderness around the surgical site (usually treated very effectively with paracetamol) and there is a small risk of infection (less than 3% under Dr Ghura). Temporary numbness or sensitivity around the scar is quite common which improves over time. We will give you detailed, careful instructions after the procedure so you know how best to manage things afterwards.
What about the Scar?
Dr Ghura uses Mohs surgery to give him the best cure rates and the smallest least deep wound with instant results. All this means the best, most optimal repair and reconstruction can then be done to give the best scar possible. Wherever we can we will disguise the scar in natural lines. Depending on the extent of surgery, Dr Ghura uses a variety of techniques for repair and reconstruction.
These options can include:
- Directly stitching the wound together (primary closure)
- Moving skin from a nearby adjacent area to repair the wound (skin flap)
- Using a skin graft from elsewhere to cover the wound
- Letting mother nature heal the wound heal on its own (secondary intention)
- Sometimes, if the wound is extensive or complex, Dr Ghura will work with other reconstructive surgeons.
How can I best prepare for Mohs Surgery?
Anaesthetic- Dr Ghura undertakes Mohs surgery in Manchester under the safety and convenience of local anaesthetic injection. The anaesthetic numbs the skin for up to 4-6 hours, so you won’t feel any discomfort during the procedure. Dr Ghura pays especial attention to giving his patients the injection as comfortably as possible. Local anaesthetic means you can usually eat or drink as normal.
Medicines: Sometimes Dr Ghura will ask you to avoid certain medicines or vitamin/herbal supplements as they can thin the blood and make surgery more difficult. Tablets include aspirin, clopidogrel, rivaroxaban, apixaban or warfarin. Similarly pain killers such as ibuprofen (brufen), diclofenac (voltarol), naproxen and anadin make you more prone to bleeding and bruising. Supplements such as garlic pearls, ginger or ginseng also thin your blood. Always let Dr Ghura know all the tablets you are taking even if they are not prescribed so he can advise you fully as many of these tablets need to be avoided several days before surgery. Equally some of these tablets may be very important for you to remain on and Dr Ghura will advise you accordingly.
Clear your day… and your week! It’s not possible for Dr Ghura to predict how long your Mohs surgery will take but it’s usually 4-6 hours. Similarly, you will not look your best (!) especially for the first 1-2 weeks after Mohs Surgery with the stitches and bruising etc and should plan your work and social life accordingly.
Avoid smoking and drinking for 2-3 days before and after- Smoking reduces your body’s ability to heal itself as well as can mean skin grafts etc don’t survive as well. Drinking makes you bleed and bruise more.
Get a good night’s sleep before!- though you may very naturally be feeling nervous!
Wear comfortable casual clothing. At some point in the procedure we will ask you to change into a gown.
Bring someone with you if you like- it helps pass time as you won’t be in theatre all the time and they can then drive you home afterwards (or you can take a taxi).