Checking that the whole skin lesion has been removed.
More precise skin cancer surgery makes it better for patients
Skin cancer is a major problem in New Zealand, and treatment can be complex. There are many different types of skin cancer, and surgery is often required. In standard skin cancer surgery a lesion is surgically removed and the wound closed without knowing if all of the cancer has been removed. It takes another couple of days before the tissue is examined under the microscope. Further surgery may be needed. Mohs surgery, the most effective way to treat skin cancer, is now available in Christchurch.
Dermatologist Tom Middelburg explains that in Mohs surgery, cancerous tissue is progressively removed in stages. “After each stage during surgery the complete excision margin of the tissue is examined under the microscope for remaining cancer cells. This process is repeated until all cancer has been removed, after which the wound is closed.”
Mohs micrographic surgery, named after Dr. Frederic Mohs who developed the technique in the 1930s, has long been an internationally recognised standard of care for high risk, nonmelanoma skin cancer.
“These differences mean that Mohs surgery yields the highest cure rates for treating skin cancer while sparing normal tissue, which in turn helps preserve functionality and reduces scarring and disfigurement,” Tom says.
In standard surgery only a fraction of the excision margin (edge of the surgical wound) is examined microscopically and tumour cells may be missed as a result.
Many studies have confirmed this increased benefit, showing success rates for Mohs surgery of 95-100 percent.
8 | Spring 2017
The requirement for operating theatre space, the necessary equipment and the need for certain specialist staff cannot currently be met on the Christchurch Hospital campus, so Mohs surgeries are outplaced to a private facility – the only publicly-funded service of this kind in the South Island. “Since starting the service in February 2017 we have performed over 50 Mohs surgeries with referrals coming from plastics, Ear Nose and Throat, ophthalmology and dermatology. General Practice can now also refer directly for Mohs through HealthPathways.” ■