for complete removal of skin cancer
for complete removal of skin cancer
WHAT IS MOHS SURGERY?
MOHS micrographic surgery is an extremely effective surgical technique, for removing skin cancer, with a cure rate of 99.7%. It is named after the American Surgeon Dr Frederic Mohs, who developed it. This surgical technique allows precise 100% microscopic control, of both the deep and the peripheral margins of the tumour. On the contrary, in conventional surgery the cancer’s removal, depends on the surgeon’s ability, to judge the extent of the cancer by eye.
Skin cancer removal in layers
The roots of skin cancer may extend beyond the visible portion of the tumour. If these roots are not removed, the cancer will recur. After local anaesthesia, Dr Zografou removes the tumour in layers. Removal in layers, under microscopic control, is done to ensure that, the “roots” that may extend under the visible part, will be also removed. This reduces the chance of recurrence of cancer, which can happen if these “roots” are left in.
Processing and microscopic examination
The tumour is processed for microscopic examination on the same day, whilst you are waiting in the Clinic. Dr Zografou examines the tissue for cancerous cells, under the microscope. If the removed tissue contains cancerous cells, another layer of tissue is removed and examined on the same day. The removal of layers, is repeated as many times as needed, until all the cancerous cells have been removed. On the contrary, after conventional surgery, you have to wait days or weeks for the histology results and it might be still positive and you will then need, a second operation.
Reconstruction of the defect
Once the skin is all clear of tumour, under the microscope, the resulting wound will be repaired on the same day, with the most appropriate reconstruction for your case. The several reconstructive options, will be discussed with Dr Zografou in detail, before your surgery.
- MOHS micrographic surgery is typically indicated for primary tumours, located in areas such as the nose, ears, eyelids, lips, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic or functional purposes.
- It is indicated for skin cancers that have recurred or for incompletely excised tumours, after conventional surgery.
- It is reserved for those skin cancers that have ill-defined margins, where is difficult to say, where the tumour borders begin and end.
- It is also indicated for tumours, which are proved to be aggressive, on initial diagnostic biopsy, like infiltrative type basal cell carcinomas.
- It is appropriate for skin cancers that develop in kidney transplanted, lymphoma and immunocompromised patients.
In conventional removal of skin cancer, the surgeon removes the tumor that is visible to the eye, removing at the same time, an area of healthy tissue around the cancer (from 4mm – 1cm, depending on the type of cancer), in order to maximize the chance of complete cancer removal, as the tumor is not processed at the same time, for examination. Therefore, conventional surgery is NOT tissue sparing. In contrast, in Mohs Surgery, skin cancer removal is performed by the Mohs surgeon, with the smallest possible removal of healthy tissue (1 – 2 mm only), around the cancer and it is tissue sparing.
In conventional surgery, the specimen is sent to the Pathology Laboratory, for histological examination. Both the surgeon and the patient, will have to wait for the results of the histological examination, which will confirm or not, the complete excision of cancer. This process, of specimen’s examination by another doctor, is time consuming and the results are available, over a period of 10 days to 1 month, depending on the laboratory and its workload. If the tumor is not completely removed, the patient should have further surgery, which becomes more difficult, as it is not always easy for the surgeon, to localize the area of residual cancer after the previous surgery (there is not a visible tumour anymore there).
Here, lies the second great difference of Mohs surgery. The microscopic examination of cancer, is performed by the Mohs surgeon, at the same time and day of the surgery and the report for the complete removal of the cancer, is given on the day of surgery, by the surgeon and not days or weeks later, by another doctor.
The second major difference of Mohs surgery, compared to conventional surgery, lies in the way the tissue is processed and examined histologically. In Mohs Surgery (horizontal sections), 100% of the tissue and all surfaces of the specimen (both the bottom and the lateral surgical margins) can be thoroughly examined, as opposed to conventional histological examination (vertical random sections) , at which a part (≈30%) of the tissue is examined at best.
- Proper and early diagnosis is the first and most important step for effective treatment. The methods we use in Derm & Plastic Surgery Clinic, due to state-of-the-art medical equipment, allow us to diagnose skin cancer accurately. In order to determine, the appropriate treatment plan for you, your full medical history should be taken and then a series of diagnostic examinations, most notably digital dermoscopy, should be carried out. With the help of a special program software and a high resolution camera, the area of skin cancer is examined in detail. A thorough screening of the rest of the body is following, to rule out the possibility of pre-cancerous lesions in other areas of the body.
- Dr Zografou performs hundreds of successful Mohs surgeries every year, for patients in Greece and abroad. The ability to perform the surgery under local anaesthesia, in the specially equipped surgical units, where the doctor operates (HYGEIA Hospital, Mediterraneo Hospital) allows the patient to return to his daily activities, from the very next day. The whole procedure, under local anaesthesia, is safer and has faster recovery, without requiring hospitalization!
- Once surgery has been completed, post-operative follow-up of our patients and digital dermoscopy is repeated at regular intervals (3, 6 and 12 months), which gives us a detailed control. Be certain that in Derm & Plastic Surgery Clinic, your skin will not be left to its fate after the surgery! Monitoring our patients is a commitment to us, as we take care to prevent further appearance of skin cancers, in our patients.
- The expertise of Dr. Zografou, in the field of Mohs Surgery, combined with her specialization, with Master (MSc) in Minimal Invasive and Robotic Surgery, guarantee you a professional and highly responsible approach, to your health problem. Dr. Zografou is the only certified Mohs surgeon in Greece (European Society of MOHS Surgery) and is one of the internationally recognized expert surgeons. She is invited every year to International Conferences, to teach other doctors and present the results of her surgeries.
FREQUENTLY ASKED QUESTIONS
How much skin is removed in MOHS Surgery in comparison to conventional surgery?
Prior to MOHS surgery, it is impossible to predict precisely, how much skin will have to be removed for the complete cure of skin cancer. The final surgical defect might only be slightly larger, than the initial lesion or it could be larger and deeper, if the cancer is invasive.
The patient should bear in mind however, that MOHS surgery removes only the cancerous tissue, while the healthy tissue is spared (tissue sparing surgery). This preservation of healthy tissue, in sensitive areas, such as the eyelids, the nose, the lips and the ears is extremely important, for functional and aesthetic purposes.
Why it is of critical importance the microscopic control in depth and at the periphery?
Skin cancers can be deceptively large – far more extensive under the skin, than they appear to be, from the surface. These cancers may have “roots” under the skin or along blood vessels and nerves.
Also skin cancers that have recurred, following previous conventional surgery may send out extensions, deep under the scar tissue, which has formed at the site. And that’s exactly, where MOHS surgery differs from other skin cancer treatments, in that it permits, the immediate and complete microscopic examination of the removed cancerous tissue, on the same day of your MOHS surgery, so that all “roots” and extensions of the cancer, can be eliminated.
For how long, I need to stay in the Clinic?
The time, that you need to spend in the Clinic, for skin cancer removal and reconstruction could be between 1 to 5 hours.
Who can be a MOHS Surgeon?
Physicians performing MOHS surgery should have specific skills in dermatology, dermatologic surgery, dermatopathology and Mohs surgery and should be certified MOHS surgeons. Commonly MOHS surgeons are qualified Dermatologic Surgeons, who had further subspecialty training in MOHS surgery for 1 year.
This training is additional, to that required to become a dermatologist. A Certified MOHS surgeon should be able to provide you with detailed information, regarding his or her certifications in the above disciplines, as well as, all applicable professional affiliations.
Is MOHS surgery the most cost-effective treatment option?
Because of MOHS surgery’s high cure rate (99,7%), patients require only a single surgery, which includes the histology and the repair of the wound. Conventional surgery might require additional surgeries and histology readings, in order to treat the cancer, if the cancer is not completely removed, by the first attempt. Each one of these additional surgeries and histology readings is not only a stressful procedure for the patient, but require separate fees, while a single MOHS surgery includes all of these fees, into one.
Therefore, MOHS surgery is a value-for-money skin cancer treatment. In any case, and because of the particularity of this surgery, which has to do with the patient’s health, we are trying to provide this extremely beneficial technique, at affordable prices, for all our patients.
COST – PRICES
The cost starts at 1200 euros and is shaped according to how many layers will be taken, to complete the cancer removal and also on the final size of the defect, which needs to be reconstructed.
Her broad, scientific training was obvious from our first meeting, as she is certified MOHS surgeon. I had the surgery done...
When I visited my previous doctor in order to remove a mole, he also suggested removing a small cyst that I had on my face and send the sample for analysis. The biopsy showed skin cancer...More Testimonials
I want to thank you publicly for your professionalism and your contribution to the evolution of Medicine in our country...
I was diagnosed with skin cancer. My family has a positive skin cancer history, so I knew that I might be diagnosed with skin cancer at some point. I chose Dr Zografou as my doctor, as I knew her...More Testimonials
Thanks to her excellent knowledge and experience, she knew exactly when the whole malignant tumor was removed...
When I diagnosed with skin cancer, I was terrified. I visited your Clinic and I was very pleased by the doctor. Dr. Zografou is an excellent doctor, with a thorough knowledge of skin cancers...More Testimonials
Learn more about MOHS surgery by Dr. Zografou, who is one of the Leading Experts Doctors in Europe, with many years of experience and expertise in the field of diagnosis and treatment of skin cancer.
Dr. Angie Zografou, MD, MSc, PhD
Consultant Dermatologist – Dermatologic Surgeon
Certified MOHS Surgeon
European Society of MOHS Surgery
Trained in England “ Oxford University”
Master in “Minimally Invasive Surgery & Robotic Surgery”
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