One of the most advanced treatments for skin cancer is named after the man who invented it in the 1930s, Dr Frederick Mohs. In Mohs' surgery, the tumour is removed piece by piece. Each piece is immediately frozen and examined under a microscope. If some cancer might still be present, more tissue is removed and examined. This goes on until there are no signs of any cancer cells. Reconstruction is then carried out.
Mohs Micrographic Surgery (MMS) relies on the surgeon also being a pathologist and identifying cancer cells. The surgery is very precise and means that the maximum amount of healthy tissue is retained, while removing cells that could cause a recurrence of the cancer.
The cure rate for MMS is up to 99 per cent for skin cancers that have not been treated by other methods and more than 90 per cent where other forms of treatment have failed.
Some tumours do not respond to common treatments, including those greater than 2cm in diameter, those in difficult locations, such as the eyelid, and tumours complicated by previous treatment. Removing a recurring skin cancer is more complicated because scar tissue makes it difficult to differentiate between cancerous and healthy tissue. Again, the Mohs approach makes effective treatment possible.
Mr Malhotra recommends MMS to treat difficult basal cell carcinomas (BCC), and squamous cell carcinomas (SCC). Both are most often caused by excessive exposure to UV light from the sun or sun beds.
It can also be used to treat less common tumours, including melanoma, sebaceous carcinoma (SG) or microcystic adnexal carcinoma (MAC) — a tumour of a facial sweat gland. These may require more than one visit as often the skin pieces need to be processed as paraffin sections, which takes considerably longer, in order to provide greater clarity.
MMS is particularly useful when: