We understand that you want to be sure Mohs surgery is the right decision. Our consultants only recommend Mohs where they believe this is the best treatment, you might also want to look at the pros and cons.
The Skin Cancer Foundation calls the technique the gold standard and states “Mohs surgery has the lowest recurrence rates, highest cure rates and best cosmetic results of any skin cancer treatment.”
Similar thoughts come from the British Association of Dermatologists, who believe “Mohs is a highly effective and cost effective technique for non-melanoma skin cancer.”
You may be wondering why we ask you to consider further, when we agree that the approach is an incredible technique. Being informed on medical care is important and not even Mohs will suit every case, as in the factors below.
Advantages Of Mohs
Alongside the highest cure rate of all current treatments for skin cancer, around 99%, Mohs has additional benefits:
- Removing exact tissue margins is part of Mohs surgery, rather than an estimate.
- The complete cancer is normally removed, eliminating chances of this growing back.
- Less healthy tissue is lost, a good situation for cosmetic and functional outcome.
- Complete surgery and repair of the surgical site is normally a same day operation.
- Mohs can bring a permanent cure to skin cancers, when other methods have failed.
We could add that the psychological impact of requiring multiple day procedures is likely to be removed, or the greater impact of skin cancer returning. There are many positives, how about the other direction.
Disadvantages Of Mohs
As with any treatment, Mohs will not be the solution in cases where other treatments may have been a better option:
- Small, superficial, low risk cancers can be successfuly treated in less invasive ways.
- Whilst same day treatment is a positive for many, this can feel a long day for some.
- As in the point above, fitness for surgery of elderly, or frail patients needs thought.
- There are cases where very unusual margins, or skin condition raise concerns.
- Mohs is not the treatment for every type of skin cancer, see below on melanoma.
There can be other considerations, such as cost, Mohs is not an inexpensive treatment. On the other hand, additional pathology testing, surgery days, or recurrence are rarities, so there may be longer term savings.
Mohs & Melanoma
Our consultants use Mohs to treat lentigo maligna, which is technically an early stage melanoma. This is however confined to the epidermis, the upper layer of the skin.
If a case has developed into lentigo maligna melanoma, when the condition spreads to the deeper layers of your skin, we do not use Mohs. Neither is the procedure used for other forms of malignant melanoma.
We appreciate that a few doctors, particularly in other countries, are using Mohs in some melanoma cases. This is partly due to special stains becoming available which help them identify melanoma cells during the procedure.
Even so, microscopic evaluation of melanoma cells can still be an issue. Melanoma is also the most dangerous of skin cancers, due to spread capabilities within the body.
NICE, or a number of professional bodies do not recommend Mohs for melanoma. Probably okay is not sufficient, skin cancer treatment should be based on near certainty.
An Overall View
For minor, low risk basal, or squamous cell carinomas on the trunk, arms and legs, treatments such as nominal surgical excision, cryosurgery, photodynamic therapy, or topical medication should be considered.
Where the problems are deeper, or on a cosmetically sensitive area, Mohs surgery is a fine solution. Not least regarding the most important consideration for consultants and patients, a permanent cure.
Neither is this type of surgery so arduous, you may be at our London clinic for a few hours, even a day but able to read a book, or use a pad to pass the time.
The key to your decision is seeing a consultant dermatologist, who is skilled in Mohs and appreciates the treatment is yours, discussion matters. If we can help in any way, by all means get in touch.