At Home with Chris Jessen 2018 - 229
remains, until all of the cancer has been
The advantage of removing and
examining the skin layer by layer is
that it ensures minimal removal of
healthy skin around the cancer,
keeping the wound as small as
possible. In this way, the surgeon can
be near certain that the cancer is
completely removed on the day of
What does it involve?
The surgeon draws a map of the
surgical site - a Mohs map - that
shows exactly how the removed tissue
corresponds to the wound, so that the
correct place for any further surgery
can be identified.
COME AND GONE,
BUT THE MOHS
SURGERY HAS STOOD
THE TEST OF TIME
The visible cancer is outlined with a
pen and the skin is numbed with a
local anaesthetic. The tumour is then
removed with a margin of healthy skin
around it. The procedure takes about
an hour. The removed tissue is
examined under the microscope to
determine whether any of the tumour
remains - if any residual tumour can be
seen, a further layer will be removed.
The surgeon will know exactly where
to find the remaining tumour by
referring to the Mohs map. This
process is repeated as many times as
is necessary until no tumour remains.
After surgery some surgical wounds
will be reconstructed.
cancer involve removing the cancer
and also an area of healthy,
unaffected skin around the cancer.
With these procedures, a pathologist
examines the excised tissue to
confirm its completeness - usually
taking about two weeks - and
determines whether further surgery
However, with Mohs surgery, the
skin cancer is removed one thin layer
at a time with a very small margin of
healthy skin surrounding it. Each layer
is immediately checked under a
microscope by a surgeon or
pathologist. Further layers are taken
from any areas in which the tumour
What are the
Bleeding, bruising, wound infection
and nerve damage are risks common
to all surgical procedures.
Mohs surgery is labour-intensive and
may seem prolonged for the patient,
especially if the cancer is difficult or
complex. An inability to remove a large
or difficult tumour in a day may delay
reconstruction after excision.
Non-contiguous tumours (those
that aren't next to each other) and/or
disconnected foci in tumours may
result in recurrence and adjunctive
therapy (a second type of therapy)
may be necessary.
MEET THE EXPERT
Dr Mohsin Ali,
MRCP (Ire), is
a consultant in
Buckinghamshire Healthcare NHS Trust.
Dr Ali founded his clinic specialising in
Mohs surgery in south Buckinghamshire
in 1998. After training in Oxford, Cardiff
and San Diego in the US, he established
the Mohs service for the benefit of
patients, dermatologists, eye surgeons
and plastic surgeons working on
complicated skin cancers.
Mohs has produced the highest
cure rates, beating previous
international statistics, and the service
was recognised by the trust for its
quality and excellence in 2014.
The clinic specialises in scar
management, mole mapping, complex
tumour treatments and all kinds of
lumps and bumps surgery, especially
of the face. The team also undertakes
Celebrities, including the late Cilla
Black, have supported Dr Ali in his
work. Cilla visited the Mohs unit at
Amersham Hospital, Buckinghamshire,
with Dr Ali on more than one occasion.
How effective is Mohs
Using Mohs micrographic surgery, the
cure rate is high for both primary (new)
tumours - up to 99% - and recurrent
ones - up to 95%.
Cure rates are significantly better
than the rates for standard excisions
(cutting out) because Mohs eliminates
the guesswork in skin cancer removal.
Combined with the preservation of
healthy tissue and minimum scarring,
owing to the precision of the technique,
Mohs micrography is now established
as the leading method for removing
many types of skin cancers.
Having been adopted by hundreds
of skin cancer surgeons, patients
around the world have benefited
from its proven methods.
FOR MORE INFORMATION
Call 01494 866600