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Mohs' Micrographic Surgery -
The Technique in Pictures

Mohs surgery has the highest cure rates for skin cancer and keeps defects as small as possible by removing the smallest amount of normal skin possible.

It is also used for poorly defined skin cancers where microscopic analysis is vital to make sure all the “roots” (subclinical invisible cancer) have been removed.

It is a specialised technique which is labour intensive and requires at least 1 year of training. I undertook my training with Dr. Neil Swanson and Dr. Ken Lee in Portland, Orgeon, USA in 2000-2001.

Here is the procedure in pictures.

     
Ill defined bcc being debulked   The 1st layer of Mohs surgeryt   Blade angled at 45°, narrow margin around debulk   Hatch marks applied
             
     
Tissue removed   Placed on map.   Close up of removed tissue   10. tissue being divided into sections
             
     
Excised specimen divided into 3 smaller specimens   Dyes to ink margins   Specimen edges being inked   Precise map to correlate with dyed specimens
             
     
Inked specimens & debulked tumour   Handed to pathology technicians   Discussion with technicians regarding specimes   Specimen fozen, mounted on chuck ready for making into slides for microscopic analysis
             
     
Technicians cut specimens   Slides being stained   Slides viewed for quaility   Slides viewed microscopically
             
     
Cancer seen   Positive areas marked out on map   Cancer seen in the 1st layer marked on map - this guides accurate removal on layer 2   Going back to the patient to accurately take a wider and deeper margin
             
     
2nd layer   New precise hatch marks   Process repeated, sections, slides, microscopic anlaysis   2nd layer shows cancer at edges so a 3rd layer will be taken just at the positive edges
             
           
A 3rd and 4th layer were needed to clear this small but ill-defined BCC            
 
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