MOHS Surgery

Before Mohs surgery, it is not possible for the Surgeon to predict how much skin will have to be removed and what the size of the final defect will be. The final defect may be slightly larger than the size of the original cancer or it may be considerably larger and deeper, if the cancer extends far enough under the skin.

Patients should be aware that in any case, only the skin affected by cancer is removed and not the healthy skin, minimizing unnecessary removal of healthy tissue. This maintenance of healthy tissue, in functionally and anatomically sensitive areas such as the eye area, nose, ears and lips, is extremely important, as every millimetre counts there. This approach allows for the highest chances of complete cancer removal, while optimizing cosmetic and functional outcomes.

We know that skin cancers can spread below the surface of the skin, beyond the visible part and have "roots" deep under the skin or spread along blood vessels and nerves. Also, cancers that have recurred after previous simple resection surgery may have spread deep below the scar of the previous surgery.

All these extensions and "roots" must be detected under the microscope and removed, during the surgery, to completely clean the cancerous area. On the contrary, in the simple conventional excision, the removal is done blindly, as it is impossible to check these areas with the naked eye. Consequently, there is a higher risk of leaving cancerous cells behind, thus increasing the chances of recurrence.

In most cases, Mohs surgery is performed on an outpatient basis, meaning you will typically not need to stay overnight in the Hospital. Mohs surgery is conducted in a specialized surgical center (Hygeia Hospital) which is equipped with the necessary facilities (cryotome, pathology lab, etc).

The length of your stay at the Hospital usually takes 2 - 6 hours and depends on various factors, including the complexity of your case and the number of stages required to remove the cancer completely. Each stage involves the removal of tissue, examination under the microscope and potential additional removal, if cancer cells are found.

While the initial removal and examination process can usually be completed within a few hours, it's important to note that Mohs surgery is a highly precise and meticulous procedure. This means that the overall duration of the surgery can vary significantly from case to case and we also need to estimate the time needed for the reconstruction of the final defect.

Mohs surgery is generally considered to be a painless procedure. The use of local anaesthesia ensures that patients do not experience discomfort or pain during the surgery itself. The Surgeon will administer the anaesthesia to numb the area being treated, ensuring that you remain comfortable throughout the procedure.

After the surgery, it is common for patients to experience minimal discomfort and tenderness at the surgical site. This can typically be managed with over-the-counter pain medications such as paracetamol. The discomfort is often described as mild and temporary and it usually subsides within a day.

Mohs Surgery will preserve as much healthy skin as possible and once the cancer is removed, the Surgeon will ensure that the reconstruction to the area leaves as minimal scarring as possible. During the reconstruction phase of the procedure, the surgeon will carefully plan and perform techniques to optimize the cosmetic outcome and minimize visible scarring. This may involve techniques such as layered closure and plastic surgery suturing to achieve the best possible aesthetic result.

It is important to note that each individual's healing process is unique and scarring can vary depending on factors such as skin type, location of the surgery and individual healing characteristics. While scars may initially appear red, raised or noticeable, they tend to improve over time. Most scars will continue to fade and flatten over the course of several months to a year.

However, it's essential to follow the Doctor's post-operative instructions, including proper wound care and scar management techniques, to optimize healing and minimize scarring. If desired, there are additional treatments available in our Clinics, such as Laser Resurfacing, that can further improve the appearance of the scar. Also, addisional are available at our Clinics, such as Fractional Laser which can improve the appearance of the post-operative scar.

Mohs surgery is often considered cost-effective due to its high cure rate and the potential for fewer surgeries and histological examinations, compared to simple conventional excision. With Mohs surgery, patients typically undergo a single operation that includes both the histological examination of the cancer and the final repair of the defect.

In contrast, simple conventional excision may require multiple surgeries and additional histological tests, which can be both a financial and psychological burden for the patient. Each additional surgery and examination incurs additional costs, which can add up over time.

Mohs surgery, on the other hand, is performed in one go and the final price includes all these costs without any additional charges for the patient. This approach can make Mohs surgery more cost-effective in the long run. Furthermore, the high cure rate of Mohs Surgery reduces the likelihood of recurrence, potentially saving the patient from further treatments and surgeries and their associated costs in the future.

While the cost of Mohs surgery can vary depending on various factors such as the location, size and complexity of the cancer, it is generally regarded as a value-for-money skin cancer treatment. In any case and because this surgery has to do with the health of the patient, in our Clinics we try to provide this extremely beneficial technique, at affordable prices for all our patients.

The Surgeon performing Mohs Surgery must be specialized in Dermatology, Dermatosurgery, Dermatopathology and Mohs Surgery and must be a Certified MOHS Surgeon. The certified Mohs Surgeon must be able to provide you with information about his training certificates in the above areas (certification from the European College of Mohs Surgery), as well as the certified number of Mohs operations he has performed.

Dr. Zografou, is the only certified Mohs Surgeon in Greece, she carries formal training and education in Mohs Surgery. Everything else mentioned on the internet is from doctors, who are not actually Mohs Surgeons, and who do not know how to do the histological examination under the microscope by themselves. The histological examination is one of the main advantages of the diagnostic accuracy of Mohs Surgery.

There are many ways that you can reduce your risk of skin cancer.

• Limit your exposure to UV radiation.
• Use broad-spectrum sunblock when exposed to the sun. Broad spectrum will help protect against both UVA and UVB rays.
• Use a minimum of SPF 30 in your sunblock and apply it thickly and frequently.
• Avoid the use of sunbeds (Using sunbeds for the first time below the age of 35 increases the risk of developing melanoma by nearly 60%).
• Perform a monthly skin self-examination looking for the ABCDE checklist for moles.