Mohs micrographic surgery is a sophisticated procedure aiming to remove facial skin tumors with serial sectioning and three-dimensional tracing of the tumor. Sequential tissue layers are microscopically analysed for the presence of cancerous cells and excised in a layered fashion until complete removal. The technique minimizes the risk of cancer recurrence in sensitive anatomic locations like the eyelid and nose and allows maximal tissue preservation, which is critical for functional and reconstructive purposes. The precision and higher success rate associated with Mohs surgery offers the advantage of immediate reconstruction and repair.
Mohs reconstruction requires subspecialised expertise and knowledge of the intricate anatomic and functional aspects of facial tissues. Dr Papageorgiou often performs reconstruction of facial tumors that due to the unexpected extent of tumor spread and size of the defect require specialised reconstructive skills.
Reconstruction is usually performed by recruiting adjacent tissues and advancing or rotating customized flaps of skin and muscle. Designing and directing the flap in a tension free manner is critical in restoring the aesthetic appearance and preserving the function of dynamic areas like the eyelids and lips or areas with distinct anatomic features like the nose.
Design and closure of the incisions is of paramount importance. Sometimes a skin or cartilage graft maybe necessary to restore structural and functional integrity. Adjuvant biological therapies and scar tissue modulators (5-fluoruracil, corticosteroids, hyaluronic acid fillers) can be implemented in the early post-operative period to maximise tissue recovery, improve healing and achieve the best possible aesthetic outcomes.
Most cases are performed under local anaesthesia and intravenous sedation may be used to ensure patient comfort. Larger and more complex defects, may necessitate MAC (Monitored Care Anaesthesia) in the operating room. These procedures typically take one to two hours and are always performed on the same day of the Mohs surgery.